床旁超声在胸外伤患者液体管理中的应用  

Application of Bedside Ultrasound in Fluid Management of Patients with Thoracic Trauma

作　　者：卞晓华[1] 夏为 耿云倩 秦延军[1] BIAN Xiao-hua;XIA Wei;GENG Yun-qian;QIN Yan-jun(Department of Emergency,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China;Department of Emergency,the 980th Hospital of PLA Joint Logistics Support Forces,Shijiazhuang 050082,China)

机构地区：[1]河北医科大学第三医院急诊科,石家庄050051 [2]中国人民解放军联勤保障部队第九八〇医院急诊科,石家庄050082

出　　处：《解放军医药杂志》2020年第9期72-76,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：河北省医学科学研究重点课题计划项目(20190604)。

摘　　要：目的探讨床旁超声在胸外伤患者液体管理中的应用价值。方法选取2016—2018年收治的严重胸外伤致肺挫伤患者60例,分别在治疗12 h、3 d、7 d进行脉搏指示连续心排血量(PICCO)检测及相关血流动力学监测,并给予急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,同时进行床旁超声检查,计算下腔静脉塌陷指数(IVC-CI),并观察上述指标与血管外肺水指数(EVLWI)的关系。结果治疗3 d、7 d时,APACHEⅡ评分、血乳酸(Lac)较治疗12 h时明显降低,氧合指数(PO 2/FiO 2)、IVC-CI较治疗12 h时明显升高(P<0.05)。治疗7 d时,EVLWI较治疗12 h时显著降低,全身血管阻力指数(SVRI)较治疗3 d时显著升高(P<0.05)。EVLWI与APACHEⅡ评分、Lac呈正相关(r=0.827、0.679,P均<0.05),与PO 2/FiO 2、IVC-CI呈负相关(r=-0.664、-0.758,P均<0.05)。结论IVC-CI与EVLWI具有显著相关性,故床旁超声可替代PICCO对严重胸外伤致肺挫伤患者进行监测。Objective To explore the application value of bedside ultrasound in fluid management of patients with thoracic trauma.Methods Sixty patients with severe lung contusion induced by thoracic trauma that were admitted from 2016 to 2018 were selected for pulse indication continuous cardiac output(PICCO)detection and related hemodynamic monitoring at 12 h,3 d and 7 d after treatment.Acute physiology and chronic health status scoring systemⅡ(APACHEⅡ)score was evaluated,and bedside ultrasound examination was performed.The inferior vena cava collapse index(IVC-CI)was calculated,and the relationship between the above indexes and extravascular lung water index(EVLWI)was observed.Results At 3 and 7 d after treatment,the APACHEⅡscore,blood lactate(Lac)were significantly lower than those at 12 h after treatment,and the oxygenation index(PO 2/FiO 2)and IVC-CI were significantly higher than those at 12 h after treatment(P<0.05).At 7 d after treatment,EVLWI was significantly lower than that at 12 h after treatment,and the systemic vascular resistance index(SVRI)was significantly higher than that at 3 d after treatment(P<0.05).EVLWI was positively correlated with APACHEⅡscore and Lac(r=0.827 and 0.679,P<0.05),and negatively correlated with PO 2/FiO 2 and IVC-CI(r=-0.664 and-0.758,P<0.05).Conclusion IVC-CI and EVLWI have a significant correlation,therefore,bedside ultrasound can replace PICCO to monitor patients with severe thoracic trauma-induced lung contusion.

关 键 词：胸外伤 肺挫伤 液体管理 床旁超声 血管外肺水 下腔静脉塌陷指数 

分 类 号：R445.1[医药卫生—影像医学与核医学] R655[医药卫生—诊断学]