超声心排血量监测指导低排高阻危重病人治疗的价值  

VALUE OF ULTRASOUND CARDIAC OUTPUT MONITOR IN GUIDING THE TREATMENT OF CRITICALLY ILL PATIENTS WITH LOW CARDIAC OUTPUT AND HIGH SYSTEMIC VASCULAR RESISTANCE

作　　者：于海洋[1,2] 山峰 王玉春[1] 朱晓岩 郝旭仲 YU Haiyang;SHAN Feng;WANG Yuchun;ZHU Xiaoyan;HAO Xuzhong(Department of Intensive Medicine, Laoshan District, The Affiliated Hospital of Qingdao University, Qingdao 266071, China)

机构地区：[1]青岛大学附属医院崂山院区重症医学科,山东青岛266071 [2]青岛市海慈医疗集团重症医学科

出　　处：《青岛大学学报（医学版）》2019年第4期456-460,共5页Journal of Qingdao University(Medical Sciences)

基　　金：青岛市医药科研指导计划项目(2016-WJZD026)

摘　　要：目的探讨超声心排血量监测(USCOM)指导低排高阻危重病人治疗的临床应用价值。方法选取2016年1月—2018年6月入住青岛市海慈医疗集团重症医学科的低排高阻病人82例,将其随机分为2组。对照组40例仅根据临床常规监测进行经验性治疗,观察组42例则根据常规监测及动态监测USCOM指标对病人进行精准化治疗。常规监测指标包括心率(HR)、平均动脉压(MAP)、血乳酸(Lac)、氧合指数(OI)、中心静脉压(CVP)、脑钠肽(BNP);USCOM指标包括心排血指数(CI)、外周血管阻力指数(SVRI)、心脏收缩期射血所用时间(FTc)。比较两组病人治疗6、12、24、48、72h血流动力学和血气分析指标的变化,血管活性药物使用剂量,28d内ICU转出率及病死率。结果观察组血流动力学和血气分析指标改善优于对照组,治疗6h时,两组仅OI比较差异有统计学意义(F=5.14,P<0.05);治疗12h时,两组HR、MAP、Lac、OI、CI、SVRI、FTc、BNP比较差异有统计学意义(F=2.84~9.87,P<0.05);治疗24、48、72h时,两组所有指标差异均有统计学意义(F=3.03~86.57,P<0.05)。治疗24、48、72h时观察组多巴酚丁胺、硝酸甘油的泵入速度显著低于对照组(F=3.21~3.98,P<0.05)。观察组28d内ICU转出率显著高于对照组(χ^2=4.383,P<0.05),病死率显著低于对照组(χ^2=4.082,P<0.05)。结论通过USCOM对低排高阻危重症病人血流动力学进行动态监测,能个体化精准指导临床治疗,减少药物的使用及住ICU的时间,降低病死率。Objective To investigate the clinical value of ultrasound cardiac output monitor (USCOM) in guiding the treatment of critically ill patients with low cardiac output and high systemic vascular resistance. Methods A total of 82 patients with low cardiac output and high systemic vascular resistance who were admitted to Department of Critical Care Medicine in Qing- dao Hiser Medical Group from January 2016 to June 2018 were enrolled and randomly divided into control group with 40 patients and observation group with 42 patients. The patients in the control group were given empiric therapy based on conventional clinical monitoring, and those in the observation group were given precision therapy based on conventional clinical monitoring and dynamic USCOM indices. Conventional clinical monitoring indices included heart rate (HR), mean arterial pressure (MAP), blood lactic acid (Lac), oxygenation index (OI), central venous pressure (CVP), and brain natriuretic peptide (BNP), and USCOM indices included cardiac output index (CI), peripheral systemic vascular resistance index (SVRI), and corrected flow time (FTc). The two groups were compared in terms of the changes in hemodynamics and blood gas parameters at 6, 12, 24, 48, and 72 h of treatment, dose of vasoactive agent, intensive care unit (ICU) discharge rate within 28 d, and mortality rate. Results The observation group had significantly greater improvements in hemodynamics and blood gas parameters than the control group, and at 6 h of treatment, there was a significant difference in OI between the two groups ( F =5.14, P <0.05);at 12 h of treatment, there were significant differences between the two groups in HR, MAP, Lac, OI, CI, SVRI, FTc, and BNP ( F =2.84-9.87, P < 0.05);at 24, 48, and 72 h of treatment, there were significant differences in all indices between the two groups ( F =3.03-86.57, P <0.05). Compared with the control group at 24, 48, and 72 h of treatment, the observation group had a significantly lower pumping speed of dobutamine and nitroglycerin ( F =3

关 键 词：超声检查 心排血量 血流动力学监测 危重病 血管阻力 治疗结果 

分 类 号：R540.4[医药卫生—心血管疾病] R445.1[医药卫生—内科学]