动态动脉弹性指导重症肺炎休克患者去甲肾上腺素的使用价值  

Value of dynamic arterial elasticity as a guide of the use of norepinephrine in patients with severe pneumonia shock

作　　者：袁满涓[1] 霍保善[1] 吴冠褀 黄永光[1] YUAN Manjuan;HUO Baoshan;WU Guanqi;HUANG Yongguang(Department of Intensive Care Unit,Foshan Second People's Hospital,Foshan 528000,China)

机构地区：[1]佛山市第二人民医院重症医学科,广东佛山528000

出　　处：《分子影像学杂志》2020年第1期82-87,共6页Journal of Molecular Imaging

基　　金：2018年佛山市医学类科技攻关项目(2018AB002521)。

摘　　要：目的探索动态动脉弹性(Eadyn)对重症肺炎休克患者去甲肾上腺素使用时机及剂量的指导效果。方法采用前瞻性观察性队列研究方法,选取2018年6月~2019年6月在佛山市第二人民医院重症医学科收治的68例行机械通气且计划使用去甲肾上腺素的重症肺炎患者,其中男性38例,女性30例,年龄27~77岁(58.60±8.72岁)。根据是否使用Eadyn监测技术,将患者分为监测组(n=32)和对照组(n=36)。监测组患者使用脉搏指示连续心排血量技术持续监测,据检测的血流动力学指标计算Eadyn,随时调整使用去甲肾上腺素;对照组患者予有创血压监测,以平衡盐溶液进行早期液体复苏目标导向性治疗。对比两组患者治疗后效果。结果两组患者开始复苏升压治疗12 h后,监测组病情评分低于对照组(P<0.05);24 h后,呼吸、循环功能相关指标,监测组优于对照组;监测组各时间段的CVP、BNP低于对照组(P<0.05)。96 h胸部CT影像比较,对照组肺部渗出明显增加,差异具有统计学意义(P<0.05)。监测组患者机械通气时间为9.47±2.7 d,对照组为14.42±2.9 d;监测组ICU住院时间11.31±3.2 d,对照组为20±2.9 d;从28 d统计来看,监测组死亡4例,病死率12.5%;对照组死亡8例,病死率22.22%,差异具有统计学意义(P<0.05)。监测组预后优于对照组。结论实时Eadyn可以指导重症肺炎休克患者加用去加甲上腺素的时机和剂量,根据动态血流动力学监测数据指导升压方案更加个体化,能够减轻脏器负荷,改善预后。Objective To explore the effect of Eadyn on norepinephrine application. Methods The study was a prospective and observative cohort study. A total of 68 patients with severe pneumonia admitted to intensive care unit(ICU) of Foshan Second People’s Hospital were enrolled from June 2018 to June 2019, including 38 males and 30 females with the age from 27 to 77 years old(average 58.60±8.72). All the patients were treated by mechanical ventilation and planned to use noradrenaline. Based on whether Eadyn was used as as an indicator for the use of norepinephrine, the patients were divided into the monitoring group(32 cases) and the control group(36 cases). The patients in the monitoring group were monitored continuously by pulse indicating continuous cardiac output(PiCCO). According to the real-time eadyn which calculated by the hemodynamic indexes, norepinephrine was adjusted at any time.Patients in the control group were monitored for invasive blood pressure.The ealy goal directed therapy(EGDT) was carried out with the balanced salt solution. The indexes were compared after treatment. Results After 12 hours of resuscitating and vasopressor treatment, the severity scores were significantly lower in the monitoring group than in the control group(P<0.05). At the beginning of 24 hours, the indexes of respiratory and circulatory function in the monitoring group were better than those in the control group. The CVP and BNP in the monitoring group were lower than those in the control group(P<0.05). Compared with the lung CT images after 96 hours, the exudation in the control group increased significantly(P<0.05). The time of mechanical ventilation in the monitoring group were 9.47±2.7 days, and that in the control group were 14.42±2.9 days. The length of stay in ICU in the monitoring group were 11.31±3.2 days,and that in the control group were 20±2.9 days. From the statistics of 28 days, 4 cases died in the monitoring group with a mortality rate of 12.5%, and 8 cases died in the control group with a mortality rate of 22

关 键 词：动态动脉弹性 重症肺炎 休克 去甲肾上腺素 

分 类 号：R459.7[医药卫生—急诊医学] R563.1[医药卫生—治疗学]