胸腔内血容量指数目标导向治疗冠状动脉搭桥术后低心排患者的效果评价  

Effect evaluation of intra-thoracic blood volume index target-directed therapy in treatment of patients with low cardiac output after coronary artery bypass grafting

作　　者：王守君[1] 翟萍 张汝敏[1] 马爽[1] 宋玮玮 王琳 Wang Shoujun;Zhai Ping;Zhang Rumin;Ma Shuang;Song Weiwei;Wang Lin(Department of Critical Care Medicine,Zibo Central Hospital,Zibo 255036,Shandong,China;Department of Internal Medicine,Shandong Guoxin Yiyang Group Zibo Hospital,Zibo 255120,Shandong,China)

机构地区：[1]淄博市中心医院重症医学科,山东淄博255036 [2]山东国欣颐养集团淄博医院内科,山东淄博255120

出　　处：《中国中西医结合急救杂志》2021年第5期551-555,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：山东省医药卫生科技发展计划项目(2009HZ112)。

摘　　要：目的研究胸腔内血容量指数(ITBVI)目标导向治疗对冠状动脉(冠脉)搭桥术后低心排血量患者的应用效果。方法采用回顾性研究方法,选择2018年6月至2020年12月在淄博市中心医院心脏外科行不停跳行心脏外科手术的211例患者作为研究对象,根据治疗方法不同将其分为ITBVI目标导向治疗组〔105例,以ITBVI、全心舒张期末容积指数(GEDVI)、血管外肺水指数(EVLWI)等为目标导向行容量管理并应用正性肌力药物〕与经验治疗组(106例,以心率、动脉血压、中心静脉压、尿量等指导治疗)。比较两组术后机械通气时间、重症监护病房(ICU)住院时间、恶性心律失常发生率、应用主动脉内球囊反搏(IABP)及连续性肾脏替代治疗(CRRT)的例数与时间、术后不同时间点液体出入量差值、临床治疗指标〔平均动脉压(MAP)、血乳酸(Lac)、N末端脑钠肽前体(NT-proBNP)、左室射血分数(LVEF)〕、氧代谢指标〔氧合指数(PiO_(2)/FiO_(2))、中心静脉-动脉二氧化碳分压差(Pcv-aCO_(2))〕以及序贯器官衰竭评分(SOFA)、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)。结果ITBVI目标导向组术后机械通气时间和ICU住院时间均明显短于经验治疗组,恶性心律失常发生率明显低于经验治疗组〔术后机械通气时间(h):25.2±9.3比33.5±12.3,ICU住院时间(d):3.6±1.5比5.5±1.8,恶性心律失常发生率:4.8%(5/105)比8.5%(9/106),均P<0.05〕;两组使用IABP和CRRT的例数与时间比较差异均无统计学意义。ITBVI目标导向组术后1 d、2 d液体出入量差值均明显低于经验治疗组〔术后1 d(mL):689.3±138.5比1479.6±415.7,术后2 d(mL):419.2±239.5比994.7±326.4,均P<0.05〕,术后3 d液体出入量差值与经验治疗组比较差异无统计学意义(mL:187.4±71.2比213.6±85.9,P>0.05)。ITBVI目标导向组治疗3 d后PiO_(2)/FiO_(2)明显高于经验治疗组〔mmHg(1 mmHg≈0.133 kPa):229.8±27.5比189.3±32.7,P<0.05〕,Lac、NT-proBNP、Pcv-aCOObjective To investigate the effects of intrathoracic blood volume index(ITBVI)target-directed therapy in patients with low cardiac output after coronary artery bypass grafting.Methods Using retrospective research methods,211 patients undergoing coronary artery bypass grafting all through heart beating in the Department of Cardiac Surgery in Zibo Central Hospital from June 2018 to December 2020 were selected as the research objects.According to the different treatment methods,they were divided into ITBVI target-directed treatment group[105 cases,using ITBVI,global end-diastolic volume index(GEDVI),extra-vascular lung water index(EVLWI),etc.as goal orientations to guide capacity management and applying positive inotropic drug]and experience treatment group(106 cases,using heart rate,arterial blood pressure,central venous pressure and urine volume to guide capacity management).The postoperative mechanical ventilation time,length of stay in intensive care unit(ICU),incidence of malignant arrhythmia,number and time of intra aortic balloon counterpulsation(IABP)and continuous renal replacement therapy(CRRT),difference of fluid inflow and outflow at different time points,clinical treatment indexes[mean arterial pressure(MAP),blood lactic acid(Lac),N-terminal pro-brain natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF)],oxygen metabolism index[oxygenation index(PiO_(2)/FiO_(2)),central venous arterial carbon dioxide differential pressure(Pcv-aCO_(2))],sequential organ failure assessment(SOFA)and acute physiology and chronic health evaluationⅡ(APACHEⅡ)were compared between the two groups.Results In ITBVI target-directed treatment group,the postoperative mechanical ventilation time and ICU hospitalization time were significantly shorter than those in experience treatment group,and the incidence of malignant arrhythmia was lower than that in experience treatment group[postoperative mechanical ventilation time(hours):25.2±9.3 vs.33.5±12.3,ICU hospitalization time(days):3.6±1.5 vs.5.5±1.8,inciden

关 键 词：胸腔内血容量指数 血管外肺水 冠状动脉搭桥术 低心排血量 中心静脉-动脉二氧化碳分压差 

分 类 号：R54[医药卫生—心血管疾病]