超声指导的强化容量管理策略应用于围生期心肌病的效果  

Efficacy of ultrasound-guided intensive volume management strategy applicated in perinatal cardiomyopathy

作　　者：王璐[1] 王卓[1] 张浩 雷佳羲 谢文杰[1] 李镇文 伍威[1] 詹丽英[1] WANG Lu;WANG Zhuo;ZHANG Hao;LEI Jiaxi;XIE Wenjie;LI Zhenwen;WU Wei;ZHAN Liying(Dept.of Critical Care Medicine,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;Dept.of Critical Care Medicine,Hubei Macheng Traditional Chinese Medicine Hospital,Macheng 438300,Hubei,China)

机构地区：[1]武汉大学人民医院重症医学科,湖北武汉430060 [2]湖北省麻城市中医医院重症医学科,湖北麻城438300

出　　处：《武汉大学学报（医学版）》2022年第4期532-536,共5页Medical Journal of Wuhan University

摘　　要：目的:分析超声指导的强化容量管理对围生期心肌病患者的治疗效果及预后的影响。方法:纳入2018年1月至2021年12月的围生期心肌病患者共49例,分为一般治疗组(22例)与超声指导的强化容量管理组(27例),统计分析2组患者治疗后各时间点平均动脉压(MAP)、中心静脉压(CVP)、下腔静脉塌陷指数(IVC-CI)、左心房前后径(LA),左心室射血分数(LVEF),左心室舒张末期内径(LVEDD)的变化情况,以及治疗后序贯器官衰竭评价(SOFA)评分、机械通气病例数、肾脏替代治疗(CRRT)病例数以及ICU住院时间、死亡病例数、总住院费用等预后指标。结果:与对照组比较,超声指导的强化容量管理组在治疗后5 d氨基端前脑钠素(NT-proBNP)水平、LA、LVEF、LVEDD均有显著改善,还可以缩短ICU住院时间,并降低总住院费用。结论:重症床旁超声是围生期心肌病重要的临床监测手段之一;超声指导的强化容量管理策略可以改善患者预后、缩短ICU住院时间。Objective:To analyze the effect of ultrasound-guided intensive volume management in the patients with perinatal cardiomyopathy and its impact on the prognosis.Methods:A total of 89 patients with perinatal cardiomyopathy from January 2018 to December 2021 were included and divided into a general treatment group(control group,22 cases)and an ultrasound-guided intensive volume management group(27 cases),and the two groups of patients were statistically analyzed.Changes in mean arterial pressure(MAP),central venous pressure(CVP),rate of inferior vena cava collapse(IVC-CI),left atrial anteroposterior diameter(LA),left ventricular ejection fraction(LVEF),left ventricular enddiastolic diameter(LVEDD)at each time point after treatment,sequential organ failure assessment(SOFA)score after treatment,the number of mechanical ventilation cases,the number of continuous renal replacement therapy(CRRT)cases,and prognostic indicators such as ICU length of stay,number of deaths,and total hospitalization costs were all statistically analyzed.Results:Compared with control group,the ultrasound-guided intensive volume management group showed significant improvements in NT-proBNP level,LA,LVEF,and LVEDD 5 days after treatment,and had shorter ICU length of stay and less overall hospital costs.Conclusion:Critical care bedside ultrasound is one of the important clinical monitoring methods for perinatal cardiomyopathy;ultrasound-guided intensive volume management strategy can improve patients′prognosis and shorten ICU stay.

关 键 词：超声 容量管理 围生期心肌病 心功能 预后 

分 类 号：R459.4[医药卫生—治疗学]