急性颅脑疾病患者早期血流动力学监测对预后的影响  

Effect of early detection of hemodynamic parameters on the prognosis of patients with acute cerebral disease

作　　者：王征[1] 骆勇[1] 贾文钗[1] 张晓燕[1] 宁辉[1] 贺春晖[1] 钟春妍[1] 

机构地区：[1]北京大学首钢医院,北京100144

出　　处：《内科急危重症杂志》2016年第3期184-186,共3页Journal of Critical Care In Internal Medicine

摘　　要：目的:了解急性颅脑疾病患者早期全身血流动力学指标对预后的影响。方法:回顾性分析55例急性颅脑疾病患者的临床资料,根据患者28 d转归情况分为死亡组(33例)和存活组(22例),患者均于发病6h内置入脉波轮廓温度稀释连续心排量监测仪(PICCO),并对患者血流动力学指标进行连续测定3天,比较2组血流动力学指标包括心功能指数(CFI)、全心射血分数(GEF)、左心室收缩指数(d Pmax)、心指数(CI)、每搏量指数(SVI)、全心舒张末期容积指数(GEDI)、胸腔内血容积指数(ITBI)、全身血管阻力指数(SVRI)、血管外肺水指数(EVLWI)、肺血管通透性指数(PVPI)等的差异;运用多因素Logistic回归方法分析可能对预后产生影响的因素。结果:2组患者格拉斯哥评分、年龄、有无呼吸衰竭等情况差异有显著性(均P<0.05),2组患者在发病后第一天d Pmax、EVLWI,第二天CFI、d Pmax、CI、SVRI、EVLWI,第三天EVLWI差异有显著性(P<0.05或P<0.01),多因素Logistic回归分析显示年龄、第一天d Pmax、EVLWI及第二天CI均为影响预后的独立因素(P值分别为0.014,0.026,0.010和0.020,OR值分别为0.747,1.009,5.397及0.038)。结论:急性颅脑损伤患者早期的全身血流动力学第一天d Pmax、EVLWI及第二天CI影响患者预后。Objective： To understand the effect of early hemodynamic parameters on the prognosis of patients with acute cerebral disease. Methods： Clinical data of 55 patients with acute cerebral disease were analyzed retrospectively. Patients were divided into death group（ 33 cases） and survival group（ 22 cases） according to the 28 day outcome. Patients were accepted pulse index continuous cardiac output（ PICCO） catheter,the hemodynamic parameters such as CFI,GEF,d Pmax,CI,SVI,GEDI,ITBI,SVRI,EVLWI and PVPI of first three days were compared between the two groups. The factors affecting the prognosis of the patients were analyzed by multiple linear regression analysis. Results： There were significant differences in the Glasgow score,age and having respiratory failure between the two groups（ P〈0. 05）. There were significant differences in d Pmax and EVLWI on the first day,and there were also significant differences in CFI,d Pmax,CI,SVRI,EVLWI on the second day and EVLWI on the third day between the two groups（ P〈0. 05 or P〈0. 01）. Logistic regression analysis showed that the age（ P = 0. 014,OR = 0. 747）,d Pmax（ P = 0. 026,OR = 1. 009） and EVLWI on the first day（ P = 0. 010,OR = 5. 397）,and CI on the second day（ P = 0. 020,OR = 0. 038） were all the independent factors affecting the prognosis of patients. Conclusion： The early hemodynamic parameters such as dpmax,EVLWI on the first day,CI on the seacond day can affect the prognosis of patients with acute cerebral disease.

关 键 词：急性颅脑疾病 血流动力学 脉搏指示及连续心排量监测 

分 类 号：R742[医药卫生—神经病学与精神病学]