脉搏轮廓心排血量监测技术在大面积烧伤患者早期补液时对心肌损害的影响  

Effects of pulse contour cardiac output monitoring technology in amelioration of myocardial damage in fluid resuscitation of patients with large area burn in the early stage

作　　者：李一[1] 张莉[1] 刘军[1] 武岳[1] 白明明[1] 余小平[1] 周军利[1] Li Yi;Zhang Li;Liu Jun;Wu Yue;Bai Mingming;Yu Xiaoping;Zhou Junli(Department of Burns, Gansu Provincial Hospital, Lanzhou 730000, China)

机构地区：[1]甘肃省人民医院烧伤科,兰州730000

出　　处：《中华烧伤杂志》2019年第8期574-579,共6页Chinese Journal of Burns

基　　金：国家自然科学基金(81460294).

摘　　要：目的分析脉搏轮廓心排血量(PiCCO)监测技术应用于大面积烧伤早期补液时改善心肌损害的监测效果。方法回顾性分析笔者单位2015年11月—2017年11月收治的符合入选标准的52例大面积烧伤患者的病历资料,其中2015年11月—2016年11月收治的27例患者以传统方法监测液体复苏[传统组,其中男18例、女9例,(43±10)岁],2016年12月—2017年11月收治的25例患者以笔者单位引进PiCCO监测设备结合传统方法监测液体复苏[PiCCO组,其中男18例、女7例,(44±10)岁]。统计2组患者伤后第1、2个24h的补液系数和补液总量,入院即刻及伤后1、2、3、4、5、6、7d的氨基末端脑钠肽前体(NT-proBNP)、心肌肌钙蛋白T(cTnT)及心肌型肌酸激酶同工酶(CK-MB)水平。对数据行重复测量方差分析、χ2检验、t检验及Bonferroni校正、Mann-WhitneyU检验及Bonferroni校正。结果(1)传统组患者伤后第1、2个24h的补液系数分别为(1.42±0.10)、(0.94±0.14)mL·kg-1·%体表总面积(TBSA)-1,PiCCO组患者第1、2个24h的补液系数分别为(1.76±0.14)、(0.85±0.08)mL·kg-1·%TBSA-1。PiCCO组患者伤后第1个24h补液系数、补液总量均明显高于传统组(t=-9.775、-4.769,P<0.01);PiCCO组患者伤后第2个24h补液系数明显低于传统组(t=2.682,P<0.05),2组患者伤后第2个24h补液总量相近(t=1.167,P>0.05)。(2)入院即刻及伤后1、2、3、4、5、6、7d,传统组患者的NT-proBNP水平分别为518(320,763)、236(98,250)、139(62,231)、172(104,185)、296(225,341)、727(642,921)、1840(1357,2081)、1005(671,1297)pg/mL,PiCCO组患者的NT-proBNP水平分别为444(206,601)、66(29,73)、54(28,75)、139(101,175)、199(106,279)、576(333,837)、833(466,1080)、485(225,710)pg/mL,PiCCO组患者伤后1、2、6、7d的NT-proBNP水平明显低于传统组(Z=-5.004、-3.967、-5.285、-4.626,P<0.01),2组患者在入院即刻及伤后3、4、5d的NT-proBNP水平相近(Z=-0.834、-0.806、-2.665、-2.153,P>0.05)。(3)入院即刻及伤后1、2、3、Objective To analyze effects of pulse contour cardiac output (PiCCO) monitoring technology in amelioration of myocardial damage in fluid resuscitation of patients with large area burn in the early stage. Methods From November 2015 to November 2017, medical data of 52 patients with large area burn hospitalized in our unit, meeting the inclusion criteria, were analyzed retrospectively. Twenty-seven patients (18 males and 9 females) with age of (43±10)years in tradition group hospitalized from November 2015 to November 2016 were monitored by traditional monitoring methods for fluid resuscitation, and 25 patients (18 males and 7 females) with age of (44±10)years in PiCCO group hospitalized from December 2016 to November 2017 were monitored by traditional monitoring methods and PiCCO monitoring equipment for fluid resuscitation. Fluid infusion coefficients and total fluid replacement volume of patients in both groups at the first and second post burn hour (PBH) 24, as well as the levels of N terminal pro B type natriuretic peptide (NT-proBNP), cardiac troponin T (cTnT), and creatine kinase MB (CK-MB) immediately on admission and post burn day (PBD) 1, 2, 3, 4, 5, 6, and 7 were recorded. Data were processed with analysis of variance for repeated measurement, chi-square test, t test and Bonferroni correction, and Mann-Whitney U test and Bonferroni correction. Results (1) The fluid infusion coefficients of patients in tradition group at the first and second PBH 24 were respectively (1.42±0.10) and (0.94±0.14)mL·kg-1·% total body surface area (TBSA)-1, and those in PiCCO group were respectively (1.76±0.14) and (0.85±0.08) mL·kg-1·%TBSA-1. Fluid infusion coefficient and total fluid replacement volume at the first PBH 24 of patients in PiCCO group were significantly higher than those in tradition group (t=-9.775,-4.769, P<0.01). Fluid infusion coefficient at the second PBH 24 of patients in PiCCO group was significantly lower than that in tradition group (t=2.682, P<0.05). There was no statistically significant di

关 键 词：烧伤 复苏术 脉搏轮廓心排血量 心肌损害 

分 类 号：R644[医药卫生—外科学]