超声心动图动态监测评估重症感染休克或多发伤低血容量休克患者容量反应性应用价值研究  

The value of echocardiography dynamic monitoring in evaluating the capacity reactivity of patients with severe septic shock and multiple injuries hypovolemia shock

作　　者：孙云飞 

机构地区：[1]武汉市红十字会医院重症监护室,湖北武汉430000

出　　处：《临床军医杂志》2018年第2期179-182,共4页Clinical Journal of Medical Officers

摘　　要：目的探讨超声心动图动态监测在重症感染休克或多发伤低血容量休克患者容量反应性评估中的应用价值。方法回顾性分析自2014年5月至2015年10月武汉市红十字会医院收治的96例重症感染休克或多发伤低血容量休克患者的临床资料,以容量负荷试验前后超声心动图动态测量的每搏量增加值为依据,将患者分入有反应组(每搏量增加值≥15%,n=50)和无反应组(每搏量增加值<15%,n=46)。比较两组患者容量负荷试验前后监护仪监测参数(心率、平均动脉压、中心静脉压)和超声心动图动态监测参数(下腔静脉呼吸异变率、主动脉峰值流速呼吸变异率、肱动脉最大速度变异率)的变化情况。结果容量负荷试验后,有反应组患者的心率低于试验前,平均动脉压、中心静脉压高于试验前,差异均有统计学意义(P<0.05);无反应组的心率、平均动脉压较试验前无明显变化,差异无统计学意义(P>0.05),中心静脉压高于试验前,差异有统计学意义(P<0.05);有反应组患者的下腔静脉呼吸异变率、主动脉峰值流速呼吸变异率、肱动脉最大速度变异率均低于试验前,差异有统计学意义(P<0.05);无反应组的下腔静脉呼吸异变率、主动脉峰值流速呼吸变异率、肱动脉最大速度变异率较试验前均无明显变化,差异无统计学意义(P>0.05)。结论超声心动图动态监测可有效评估重症感染休克或多发伤低血容量休克患者的容量反应性,根据监测结果实施针对性液体治疗,能够提高治疗的安全性。Objective To investigate the value of echocardiography dynamic monitoring in evaluating the capacity reactivity of patients with severe septic shock and multiple injuries hypovolemia shock. Methods A retrospective study was performed on 96 cases of patients with severe septic shock or multiple injuries hypovolemia shock from May 2014 to October 2015. Based on the change rate of stroke volume（ SV） detected by echocardiography before and after load test,patients were divided into the responsive group（ change rate of SV≥15%,n = 50） and unresponsive group（ change rate of SV 15%,n = 46）. The changes of parameters monitored such as heart rate（ HR）,mean arterial pressure（ MAP）,central venous pressure（ CVP） and parameters monitored by echocardiography（ mutation rate of inferior vena cava respiratory,mutation rate of aortic peak velocity and mutation rate of brachial artery maximum velocity） before and after load test were compared. Results After load test,in the responsive group,the HR was lower than that before the test,and the MAP and CVP were higher than those before the test,and the differences were statistically significant（ P〈0. 05）; in the unresponsive group,the HR and MAP had no significant change than those before the test,and there was no statistically significant difference（ P〉0. 05）,CVP was higher than that before the test,and the difference was statistically significant（ P〈0. 05）. In the responsive group,the inferior vena cava respiration mutation rate,aorta peak velocity mutation rates,brachial artery maximum velocity mutation rates were lower than those before the test,and the differences were statistically significant（ P〈0. 05）; in the unresponsive group,the inferior vena cava respiration mutation rate,aorta peak velocity mutation rates,brachial artery maximum velocity mutation rates were not significantly changed,and the difference was statistically significant（ P〉0. 05）. Conclusion The clinical hemodynamic parameters monitored by echocardiograp

关 键 词：超声心动图 动态监测 重症感染休克 多发伤低血容量休克 容量反应性 

分 类 号：R445.1[医药卫生—影像医学与核医学]