吸气保持法与循环停止法测定 静脉回流参数的对照研究  

Control study of inspiratory holding and circulatory arresting method in the determination of parameters of venous return

作　　者：杨万杰[1] 冯庆国[1] 安友仲[2] 王晴[1] 赵雪峰[1] 李昶[1] 王伟[1] 魏凯[1] 张茹梅[1] 滕洪云 

机构地区：[1]天津市第五中心医院重症医学科,300450 [2]北京大学人民医院重症医学科,100044

出　　处：《中华危重病急救医学》2016年第11期1009-1013,共5页Chinese Critical Care Medicine

基　　金：天津市滨海新区医药卫生科技项目（2012BWKL002）;天津市滨海新区塘沽科技兴区项目（2013KJXQ01）;国家发明专利（ZL201210195200.8）

摘　　要：目的：观察吸气保持法与循环停止法在测定静脉回流参数时的差异，验证吸气保持法在床旁测定静脉回流参数的可行性。方法实验动物为健康杂种家猪，根据对同一只动物先后实施的测量方法不同分为吸气保持组和循环停止组。第一步：按照12s吸气保持法描记出第一条静脉回流曲线，获得第一个平均体循环充盈压（Pmsf1）；随后15min内快速输入0.9%羟乙基淀粉氯化钠溶液500mL，然后用同样方法描记第二条静脉回流曲线，获得第二个平均体循环充盈压（Pmsf2）；再通过转换坐标图的方法，获得Pmsf1、Pmsf2对应的应激容积（Vstress1、Vstress2）。第二步：获得Pmsf2和Vstress2后，立即实施循环停止措施，当心电波显示平直、各压力数值稳定后，即获得循环停止时的平均体循环充盈压（Pmsf3）；随后放血，待血液不再流出且各压力点稳定在0mmHg（1mmHg＝0.133kPa）时，计算此时间段所有流出液体量与所有输入液体量的差值，即获得循环停止时的应激容积（Vstress3）。比较两种方法获得的静脉回流参数（Pmsf2与Pmsf3，Vstress2与Vstress3）并进行统计学分析。结果最后有50只动物完成了实验观察。①描记两条静脉回流曲线之间输入液体前后血流动力学参数变化：与输液前比较，输液后心率（HR）和平均动脉压（MAP）无明显改变〔HR（次/min）：110.88±8.95比113.70±7.84，t＝1.677，P＝0.097；MAP（mmHg）：114.04±5.25比112.46±5.04，t＝-1.534， P＝0.128〕，中心静脉压（CVP）、心排血量（CO）和全心舒张期末容积（GEDV）均明显升高〔CVP（mmHg）：6.24±0.87比3.92±0.75，t＝-14.265，P＝0.000；CO（L/min）：5.98±0.15比5.45±0.12，t＝-19.741，P＝0.000；GEDV（mL/kg）：735.46±12.56比676.62±6.67，t＝-29.268，P＝0.000〕。②吸气保持法与循环停止法获得的静脉回流参数比较差异均无统计学意义〔Pmsf2与Pmsf3（mmHg�Objective To explore the correlation of inspiratory holding and circulatory arresting method in the determination of venous reflux parameters and validate the feasibility of inspiratory holding method determination for venous return parameters at the bedside. Methods Health mongrel pigs were divided into inspiratory holding and circulatory arresting groups based on the measurement methods implemented in them. Firstly, the first venous return curve was traced according to the 12 seconds inspiratory holding method and the first mean circulatory filling pressure （Pmsf1） was obtained. Then 500 mL 0.9% hydroxyethyl starch sodium chloride solution was infused rapidly within 15 minutes, and the second venous return curve was traced by the same way and the second mean circulatory filling pressure （Pmsf2） was obtained. Besides, based on the method of conversion of axis, the stress volume of Pmsf1 and Pmsf2 （Vstress1 and Vstress2） were calculated. Secondly, circulatory arresting was implemented immediately following Pmsf2 and Vstress2, and the mean circulatory filling pressure （Pmsf3） was obtained when the electrocardiogram oscilloscope was straight and pressure numerical was stable; following Pmsf3, bloodletting was started and the blood volume was recorded when the bloodletting stopped and pressure points were stable at 0 mmHg （1 mmHg = 0.133 kPa）. The stress volume （Vstress3） can be obtained from the gap of liquids in and out during this period. Finally, venous return parameters （Pmsf2 and Pmsf3, Vstress2 and Vstress3） obtained by those two methods were compared and statistically analyzed. Results Finally, 50 animals were observed. ① Comparison of hemodynamic parameters between the venous return curve after the infusion was traced： there were no significant differences in heart rate （HR） and mean arterial pressure （MAP） before and after liquid infusion [HR （bpm）： 113.70±7.84 vs. 110.88±8.95, t = 1.677, P = 0.097; MAP （mmHg, 1 mmHg = 0.133 kPa）： 112.46±5.04 vs. 114.0

关 键 词：静脉回流 体循环充盈压 应激容积 吸气保持 

分 类 号：R459.7[医药卫生—急诊医学]