胸阻抗法无创血流动力学监测联合IABP在13例心脏术后低心排中的应用  

A retrospective study on noninvasive hemodynamic monitoring with thoracic electrical bioimpedance combined with intra-aortic balloon pump for low cardioac output syndrome after open heart surgery

作　　者：瞿星光[1,2] 张朝晖[1,2] 龚勋[1,2] 周刚[1,2] 张蓉[1,2] 曾超[1,2] 李灵丰[1,2] 

机构地区：[1]三峡大学第一临床医学院 [2]宜昌市中心人民医院重症医学科,湖北宜昌443003

出　　处：《临床急诊杂志》2011年第3期169-171,共3页Journal of Clinical Emergency

摘　　要：目的:探讨胸腔阻抗法监测联合主动脉内球囊反搏在心脏术后低心排综合征的临床疗效。方法:对214例心脏手术后患者均早期行胸腔阻抗法监测其血流动力学变化,对其中发现的低心排综合征患者,立即行主动脉内球囊反搏(IABP)治疗。记录从开始使用胸腔阻抗法监测到应用IABP的时间、IABP持续使用时间;IABP治疗前、后血流动力学参数变化和尿量、动脉血气变化以及预后。结果:13例患者从术后实施监测到诊断低心排综合征所需时间为(13.2±4.2)h,IABP持续使用时间为(92±30.7)h;使用IABP前后血流动力学参数均有明显改善(P<0.05);动脉血气亦有显著好转(P<0.05),尿量增多(P<0.05);本组患者11例顺利拔管并治愈出院,2例死亡。结论:胸腔阻抗法监测血流动力学变化对及早发现和诊断心脏术后LCOS具有较高的应用价值,而早期使用主动脉内球囊反搏能提高此类患者的救治成功率。Objective：To investigate the clinical efficacy of thoracic impedance monitoring combined aortic balloon pump（IABP） in the treatment of low cardiac output syndrome（LCOS） after cardiac surgery Method：Hemodynamic changes of two hundred and fourteen cases of patients early after cardiac surgery were monitored with thoracic impedance monitor.Patients discovered with LCOS accepted IABP therapy immediately.The time from starting thoracic impedance monitoring to the application of IABP,the duration of IABP;the changes of hemodynamic parameters and urine output before and after IABP therapy,arterial blood gas changes and prognosis were recorded.Result：The time from the implementation of the monitoring to the diagnosis of postoperative LCOS time required（13.2±4.2） hours in thirteen patients.The duration of IABP is（92±30.7） hours.The hemodynamic parameters significantly improved before and after IABP（P0.05）;arterial blood gases also significantly improved（P0.05）and the urine volume increased（P0.05）.This group of patients extubated successfully and 11 patients recovered and 2 died.Conclusion：Monitoring of hemodynamic changes by thoracic impedance on early detection and diagnosis of LCOS after cardiac surgery has a high application value,and early use of IABP can increase the success rate of treatment of such patients.

关 键 词：胸腔阻抗法 血流动力学 主动脉内球囊反搏 低心排综合征 

分 类 号：R541[医药卫生—心血管疾病]