生物电阻抗技术评价胸部大手术后患者容量状况  

Assessing the situation of volume in the patients with major thoracic operations by bioimpedance spectrum analysis

作　　者：王剑强[1] 孟超[2] 李强[2] 

机构地区：[1]北京大学第三医院第二门诊部,北京100096 [2]北京大学第三医院危重医学科,北京100191

出　　处：《中国误诊学杂志》2012年第14期3450-3452,共3页Chinese Journal of Misdiagnostics

摘　　要：目的利用多频生物电阻抗测量法评价胸外科胸部大型手术后患者体液分布变化。方法选择2009—01—2010—12收住北京大学第三医院危重医学科的胸部大手术术后男性患者34例，利用多频生物电阻抗法Xitron4200（XitronTechnologies，SanDiego，CA，USA）在患者转入危重医学科即刻检测其细胞外水（ECW）、细胞内水（ICW）数值，同时进行血气分析、测量中心静脉压和平均动脉压。按照患者转入后24h内有无出现低血压（SBP〈90mmHg），将患者分为低血压组和血压正常组，比较低血压组和血压正常组患者的ECW、ICW、碱剩余（BE）、血乳酸（LAC）、平均动脉压（MAP）和中心静脉压（CVP）的平均值。结果有11例患者在术后24h内发生低血压。术后转入危重医学科即刻的ECW值平均值在低血压组患者明显低于血压正常组患者。术后转入危重医学科即刻的ICW值、BE值、LAC值、MAP和CVP平均值在低血压组患者和血压正常组患者之间比较未见有明显差异。结论多频生物电阻抗技术测量ECW值能在胸部大手术术后早期提示容量不足的存在。Objective To evaluate the change of the postoperative fluid distribution in patients with major thoracic operations by whole-body bioimpedance spectroscopy. Methods A total of 34 patients received major thoracic operations in ICU of the Third Hospital of Peking University from the January 2009 to December 2010 were divided into two groups according to whether or not hypotension （the systolic pressure were lower than 90 mm Hg） occured within the 24 hours after operations. Intracellular water （ICW） and extracellular water （ECW） were measured by whole-body multiple-frequency bioimpedance spectroscopy （ Xitron Technologies, San Diego, CA, USA ） when the pa- tients were admitted in the ICU. The base excess （BE}, Lactic acid （LAC） ,the mean arterial pressure （MAP）and central venous pressure {CVP） were also measured on the same time. These variables were analyzed by t test for continuous variables. Results The hypotension occurred in 11 patients within 24 hours after operations. The average ECW measured when the patients were admitted in ICU in hypotensive group is lower than that in normal blood pressure group （ P〈0. 05 ）. The average ECW, BE, LAC, MAP and CVP are no difference between the hypotensive group and normal blood pressure group （P〉0.05 ）. Conclusions Measuring the ECW by bioimpedance spectrum analysis can indicate the absence of volume in the patients with major thoracic operations in the early stage.

关 键 词：电阻抗 胸外科手术 体液分布 

分 类 号：R655[医药卫生—外科学]