每搏连续无创血压监测系统在风湿性二尖瓣狭窄合并小左心室患者术后的应用研究  

Continuous non-invasive arterial pressure monitoring system in patients with rheumatic mitral stenosis comorbid with small left ventricle after mitral valve replacement

作　　者：范桥连 丁杭[1,3] 黄廷烽 林风辉[1,2] 薛贻敏[1,2] Fan Qiaolian;Ding Hang;Huang Tingfeng;LIN Fenghui;XUE Yimin(Shengli Clinical College of Fujian Medical University,Fuzhou 350001,China;The Fourth Department of Intensive Care Unit,Fujian Provincial Hospital,Fuzhou 350001,China;Department of Cardiovascular Surgery,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院,福州350001 [2]福建省立医院重症医学四科,福州350001 [3]福建省立医院心血管外科,福州350001

出　　处：《创伤与急诊电子杂志》2021年第2期85-89,共5页Journal of Trauma and Emergency(Electronic Version)

基　　金：福建省重症医学中心建设项目(2017-510);福建省立医院“创双高”火石基金项目(2019HSJJ16)。

摘　　要：目的分析每搏连续无创血压(continuous non-invasive arterial pressure,CNAP)监测系统在风湿性二尖瓣狭窄合并小左心室患者术后的应用价值。方法选取福建省立医院2019年1月至2020年1月收治的60例风湿性二尖瓣狭窄合并小左心室患者作为研究对象,按随机数字表法将患者分为对照组(n=30)与观察组(n=30)。对照组实施常规心电监护、有创动脉血压(invasive blood pressure,IBP)监测、中心静脉压(central venous pressure,CVP)监测、床旁重症超声等进行二尖瓣置换术后血流动力学监测并指导液体治疗,观察组在对照组监测技术基础上联合应用CNAP监测系统进行术后血流动力学监测并指导液体治疗,比较两组患者术后第12小时CVP、平均动脉压(mean arterial pressure,MAP)、中心静脉血氧饱和度(central venous oxygen saturation,S_(cv)O_(2))、乳酸清除率;以及比较升压药物使用时间、机械通气时间、住重症监护病房(Intensive Care Unit,ICU)时间、术后28d并发症与死亡率。结果观察组术后第12小时CVP低于对照组(t=﹣2.807,P<0.05),MAP高于对照组(t=3.870,P<0.05),S_(cv)O_(2)高于对照组(t=3.116,P<0.05)、乳酸清除率高于对照组(t=2.830,P<0.05),差异均有统计学意义;观察组升压药物使用时间少于对照组(Z=﹣2.292,P<0.05),机械通气时间少于对照组(Z=﹣2.055,P<0.05),住ICU时间少于对照组(Z=﹣1.974,P<0.05),差异均有统计学意义;观察组术后28d并发症发生率低于对照组(χ^(2)=27.524,P<0.05),死亡率低于对照组(χ^(2)=6.793,P<0.05),差异均有统计学意义。结论CNAP监测系统用于监测风湿性二尖瓣狭窄合并小左心室患者术后血流动力学指标并指导液体治疗,可以及早发现血流动力学变化,对于稳定循环具有无创、连续等特性。Objective To analyze the application value of continuous noninvasive arterial pressure(CNAP)monitoring system in patients with rheumatic mitral stenosis comorbid with small left ventricle after mitral valve replacement.Methods Sixty patients with rheumatic mitral stenosis comorbid with small left ventricle in our hospital from January 2019 to January 2020 were selected,and they were randomly divided into control group(n=30)and observing group(n=30).The control group received routine ECG monitoring,invasive arterial continuous blood pressure monitoring(IBP),central venous pressure(CVP)monitoring and bedside critical care ultrasonography for early postoperative hemodynamic monitoring and goal-directed fluid therapy.In the observing group,CNAP technique was applied for early postoperative hemodynamic monitoring and fluid treatment on the basis of the above monitoring technology.CVP,mean arterial pressure(MAP),central venous oxygen saturation(S_(cv)O_(2))and lactic acid clearance rate were compared between the two groups 12 hours after surgery.Duration of antihypertensive use and mechanical ventilation,ICU length of stay,complications and mortality 28 days after surgery were also compared between the two groups.Results CVP of observing group was lower than that of control group at the 12th hour after surgery(t=﹣2.807,P<0.05).MAP was higher than that of control group(t=3.870,P<0.05),S_(cv)O_(2) was higher than that of control group(t=3.116,P<0.05),and lactic acid clearance rate was higher than that of control group(t=2.830,P<0.05).Duration of antihypertensive use in the observing group was less than those in the control group(Z=﹣2.292,P<0.05),mechanical ventilation was less than those in the control group(Z=﹣2.055,P<0.05),and ICU length of stay was less than those in the control group(Z=﹣1.974,P<0.05).The incidence of complications 28 days after surgery in the observing group was lower than those in the control group(χ^(2)=27.524,P<0.05),and the mortality in the observing group was lower than those in the con

关 键 词：小左心室 血流动力学 每搏连续无创血压监测系统 

分 类 号：R654.2[医药卫生—外科学]