床旁检测技术在ICU急性肺栓塞患者中的应用  

The Application of POCT in the Acute Pulmonary Embolism Patients of ICU

作　　者：张蔚[1] 周冬梅[2] 费建文[3] 唐燕[3] 

机构地区：[1]山东省烟台市烟台山医院ICU,山东烟台264001 [2]山东省烟台市烟台山医院肿瘤科,山东烟台264001 [3]山东省烟台市烟台山医院呼吸内科,山东烟台264001

出　　处：《医学综述》2013年第16期3049-3051,共3页Medical Recapitulate

摘　　要：目的探讨床旁各种监测、检测技术在ICU肺栓塞患者早期诊断中的价值。方法选择烟台市烟台山医院ICU 2009年1月至2012年11月经CT肺血管造影确诊的肺动脉栓塞(PE)患者36例,其中大面积肺栓塞11例,非大面积25例。回顾性分析上述患者于转入ICU时生命体征(体温、心率、呼吸频率、收缩压),并与其基础值进行比较,同时记录其血气分析(PO2和PCO2)、C反应蛋白(CRP)、肌钙蛋白T(TNT)、B型尿钠肽(BNP)、D-二聚体指标,行中心静脉置管,检测中心静脉压(CVP),并搜集其心电图、床旁彩超、床旁计算机X线摄影片等资料。结果治疗后肺动脉栓塞患者的心率、呼吸频率高于治疗前,收缩压低于治疗前(P<0.05);大面积肺栓塞患者CRP、TNT、BNP水平较非大面积肺栓塞组显著升高(P<0.05),两组患者均有CVP异常升高(P>0.05);床旁心脏彩超最多见表现为三尖瓣反流,床旁CR片为单侧膈肌升高,心电图表现最多为窦性心动过速。结论根据患者的生命体征,结合各种床旁监测技术,有利于肺栓塞的早期诊断,而CRP、TNT、BNP有利于病情程度及预后的判断。Objective To discuss the clinical value of point of care testing（POCT） in the early diagnosis of acute pulmonary emobolism in the ICU.Methods During January 2009 and November 2012 from Yantai Mountain Hospital,36 patients diagnosed as PE by CTPA were selected and divided into two groups of large area emolism（11 cases） and without large area emolism（25 cases）.Vital signs（T,P,R,BP） when transferred to ICU was retrospectively analyzed,then compared with basis values;at the same time,the blood gas analysis（PO2,PCO2,CRP,TNT,BNP,D-dimer） were recorded,central venous catheter indwelling was conducted,the CVP was detected,and the data of electrocardiogram,bedside color Doppler,bedside CR and so on were collected.Results After treatment,PE patients pulse,respiratory rate were higher than before treatment,systolic blood pressure was lower than before treatment（P 0.05）.CRP,TNT,BNP levels in patients with massive pulmonary embolism were significantly higher than non-massive pulmonary embolism group（P 0.05）,both groups of patients had abnormally elevated CVP（P 0.05）.Most common manifestation of bedside echocardiography was tricuspid regurgitation,of bedside CR twas unilateral elevated diaphragm,ECG mostly showed sinus tachycardia.Conclusion POCT combined with vital signs are good for the early diagnosis of acute pulmonary emobolism,and CRP,TNT,BNP are good for the severity and prognosis judgment.

关 键 词：急性肺栓塞 床旁检测技术 诊断 

分 类 号：R563.5[医药卫生—呼吸系统]