动态动脉弹性对冠状动脉旁路移植术后患者减少去甲肾上腺素剂量后血压反应性的预测价值  

Dynamic arterial elastance predicts arterial pressure response when decreasing the norepineph- rine dosage in shock after coronary artery bypass graft

作　　者：梁锋鸣[1] 王秋卉[1] 许红阳[1] 杨挺[1] 董亮[1] 金科[1] 严正[1] 严洁[1] 

机构地区：[1]南京医科大学附属无锡市人民医院重症医学科,江苏无锡214023

出　　处：《中国急救医学》2017年第11期1015-1019,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的评价动态动脉弹性（Eadym）对冠状动脉旁路移植术（CABG）后并发休克患者减少去甲肾上腺素（NE）剂量后血压反应性的预测效能。方法采用前瞻性观察研究方法纳入82例拟减少NE剂量的CABG术后并发休克的患者。通过脉搏指示连续心排量监测技术（PiCCO）监测并记录减少NE剂量前后血流动力学的参数与变量，将平均动脉压（MAP）下降≥15％定义为血压有反应性。通过受试者工作特征（ROC）曲线评价Eadym预测减少NE剂量后血压反应性的临床价值。结果本研究共纳入82例患者，有反应组36例，无反应组46例。有反应组Ea如低于无反应组（P〈0．05）。以Eadvn≤0．96评价减少NE剂量后血压反应性，敏感度为94．4％，特异度为87．0％。结论在CABG后并发休克患者应用NE时，Eadym能够预测减少NE剂量后的血压下降。Objective To evaluate dynamic arterial elastance （ Eaayn ） as a predictor of arterial pressure response when decreasing the norepinephrine （NE） dosage in shock after coronary artery bypass graft （CABG）. Methods A prospective observation of 82 patients suffering from shock after coronary artery bypass graft （CABG） for whom the physician planned to decrease the NE dosage was preformed. Measurements of hemodynamic and PiCCO variables were recorded before and after decreasing the NE dosage. Arterial pressure responsiveness was defined as a ≥ 15% decrease in mean arterial pressure （MAP）. The correlation between Eadya and arterial pressure responsiveness when decreasing the NE dosage was analyzed with receiver operating characteristic （ ROC ） curve. Results 82 patients with shock after CABG were conducted, with 36 in responsive group and 46 in unresponsive group. Eadyn was lower in responders than in nonresponders （ P 〈 0. 05 ）. Eadyn ≤ 0.96 was found to predict arterial pressure responsiveness with a sensitivity and specificity of 94. 4% and 87. 0%, respectively. Conclusion In patients with shock after CABG treated with NE, Eadyn may predict the decrease in arterial pressure when decreasing NE dose.

关 键 词：冠状动脉旁路移植术(CABG) 休克 去甲肾上腺素(NE) 动脉 弹性 

分 类 号：R654.2[医药卫生—外科学]