系统血管阻力指数对感染性休克患者血管活性药物应用的指导价值  

Guiding value of systemic vascular resistance index for vasoactive drugs used in septic shock patients

作　　者：叶宁[1] 骆雪萍[1] 施善阳[1] 

机构地区：[1]桂林医学院附属医院重症医学科,广西桂林541001

出　　处：《重庆医学》2014年第2期179-181,共3页Chongqing medicine

摘　　要：目的分析感染性休克患者中血管活性药物的应用对血流动力学的影响,探讨系统血管阻力指数(SVRI)对血管活性药物应用的指导价值。方法回顾性分析2010年3月至2012年4月入住该院重症医学科的感染性休克患者21例,应用PiCCO技术监测其心脏指数(CI)、胸腔内血容量指数(ITBI)、系统血管阻力指数(SVRI)及平均动脉压(MAP),每6~8小时监测一次。以ITBI>850mL/m2作为容量正常的标准,收集所有符合标准的患者数据共202例。以MAP是否大于65mm Hg作为分组标准(MAP<65mm Hg组,MAP≥65mm Hg组),比较两组数据血流动力学参数的差异性,在MAP≥65mm Hg组中根据SVRI的不同分为3组(1、2、3组),比较不同SVRI组时血压、心功能及容量的特点。结果 MAP<65mm Hg组和MAP≥65mm Hg组的ITBI均高于正常值,MAP≥65mm Hg组的CI、SVRI值均高于MAP<65mm Hg组(P<0.05),而ITBI在两组中差异无统计学意义。MAP≥65mm Hg组根据SVRI的不同分为的3组,所有例数中ITBI都高于正常上限,且3组比较时,仅1、3组比较差异有统计学意义(P=0.47)。SVRI低下时,CI高于正常值,随着SVRI的增加,MAP逐步增高,CI逐步下降,当SVRI过高时,MAP无明显增加,而CI值低于下限。结论对感染性休克患者进行SVRI监测,有助于指导血管活性药物的应用,其低下时提示血管反应性下降,过高时提示心功能低下,且过度收缩血管并不能进一步提升血压。Objective To analyze the influence of vasoaetive drugs on hemodynamics in septic shock patients and to explore the guiding value of systemic vascular resistance index（SVRI） for the application of vasoactive drugs. Methods 21 cases of septic shock in ICU from March 2010 to April 2012 were retrospectively analyzed. The PiCCO monitor technique was applied to monitor the he- modynamic parameters including the cardiac index（CI）, intrathoraeic blood volume index（ITBI）, systemic cenous resistance index （SVRI） and mean arterial pressure（MAP） ,once per 6--8 h. ITBI^850 mL/m2 was taken as the normal criterion. The data of 202 cases meeting the criterion were collected. These cases were divided into two groups according to whether MAP reach 65 mm Hg, the differences of hemodynamic parameters between the two groups were compared. The MAP≥65 mm Hg group was redivided in to the group 1,2 and 3 according to SVRI. Blood characteristics of pressure,CI and ITBI were compared among these 3 groups. Re- sults The ITBI value in the MAP〈65 mm Hg group and the MAP≥65 mm Hg group was higher than the normal value. The CI and SVRI values in the MAP≥65 mm Hg group were higher than those in the MAP% 65 mm Hg group（P〈0.05） ,while the ITBI value had no difference between the two groups. The ITBI values in the three groups with different SVRI all were higher than the upper normal limit, furthermore,in the comparisons among 3 groups,only comparison between the group 1 and the group 3 had sta- tistical difference（P= 0. 47）. When SVRI was lower, the CI value was higher than the normal value. Along with the increase of SVRI, MAP increased gradually,and CI gradually declined. When SVRI was too high, MAP had no significant increase, but the CI value was lower than the lower limit. Conclusion The SVRI monitoring by PiCCO can help to guide the application of vasoactive drugs in septic shock patients,lower SVRI means the declined vascular reaction and higher SVRI indicates the low cardiac function, moreover blood pr

关 键 词：休克 脓毒性 血管阻力 血管活性药物 心脏指数 胸腔内血容量指数 平均动脉压 

分 类 号：R459.7[医药卫生—急诊医学]