VA-ECMO治疗模式下超声动态监测心脏血流动力学的价值  

The value of ultrasound dynamic monitoring of cardiac hemodynamics in VA-ECMO treatment mode

作　　者：欧阳飞[1] 郭伟[2] 曹媛媛[3] 张彤[1] OUYANG Fei;GUO Wei;CAO Yuanyuan;ZHANG Tong(Ultrasonic Medical Center,The First People′s Hospital of Chenzhou,Chenzhou,Hunan 423000,China;Intensive Medicine DivisionⅠ,The First People′s Hospital of Chenzhou,Chenzhou,Hunan 423000,China;Intensive Care Medical DivisionⅢ,The First People′s Hospital of Chenzhou,Chenzhou,Hunan 423000,China)

机构地区：[1]郴州市第一人民医院超声医学中心,湖南郴州423000 [2]郴州市第一人民医院重症医学科一区,湖南郴州423000 [3]郴州市第一人民医院重症医学科三区,湖南郴州423000

出　　处：《现代医药卫生》2022年第22期3805-3809,3815,共6页Journal of Modern Medicine & Health

基　　金：湖南省卫生健康委员会科研课题(202117010670);郴州市科学技术局科技发展计划项目(ZDYF2020113)。

摘　　要：目的探讨静脉动脉体外膜肺氧合(VA-ECMO)治疗模式下超声动态监测血流动力学的价值。方法选取2019年1月至2021年3月在该院重症监护病房(ICU)行VA-ECMO支持治疗的42例患者作为研究对象,脱机成功患者26例(成功组),脱机失败患者16例(失败组),所有患者在VA-ECMO建立前、脱机前、脱机后进行超声动态监测,监测患者血流动力学、生化指标及左室射血分数(LVEF)、左室流出道速度-时间积分(LVOT-VTI)和LatSa并进行对比分析。结果成功组患者脱机前后肌钙蛋白I(cTnI)、乳酸脱氢酶(LDH)、肌酸激酶(CK)均明显低于建立前,差异均有统计学意义(P<0.05),失败组患者脱机后cTnI、CK水平均明显高于建立前,差异均有统计学意义(P<0.05);成功组患者脱机后LVEF、LVOT-VTI较脱机前均明显升高,差异均有统计学意义(P<0.05),失败组患者脱机后LVEF较脱机前明显降低,差异有统计学意义(P<0.05)。Pearson线性相关分析成功组患者收缩压、舒张压、cTnI、LDH、CK、LVEF、LVOT-VTI,发现患者收缩压、舒张压、LVEF、LVOT-VTI均呈正相关(P<0.05);cTnI、LDH、CK呈负相关(P<0.05)。结论超声动态监测血流动力学是VA-ECMO支持治疗患者必不可少的辅助检查,血流动力学的恢复情况可作为VA-ECMO支持治疗的脱机治疗的重要指标,能够更加准确地评估患者的治疗效果。Objective To study the value of ultrasound dynamic monitoring of hemodynamics in the treatment mode of veno-arterial extracorporeal membrane oxygenation(VA-ECMO).Methods A total of 42 patients who received VA-ECMO support treatment in our hospital were selected as study subjects,including 26 patients with successful offline(successful group)and 16 patients with failed offline(failed group).All patients were monitored dynamically by ultrasound before VA-ECMO establishment,before and after offline,hemodynamics,biochemical indexes,left ventricular ejection fraction(LVEF),left ventricular outflow tract velocity time integral(LVOT-VTI)and LatSa were monitored and compared.Results The levels of cTnI,LDH and CK in the successful group were significantly lower than those before establishment(P<0.05),while those in the failed group were significantly higher than those before establishment(P<0.05).The LVEF and LVOT-VTI of the successful group were significantly higher than those before offline(P<0.05),and the LVEF in the failed group was significantly lower than those before offline(P<0.05).Pearson linear correlation analysis was used to analyze systolic blood pressure,diastolic blood pressure,cTnI,LDH,CK,LVEF,and LVOT-VTI in the successful group.It was found that systolic blood pressure,diastolic blood pressure,LVEF and LVOT-VTI were positively correlated(P<0.05);cTnI,LDH,and CK were negatively correlated(P<0.05).Conclusion Ultrasound dynamic monitoring of hemodynamics is an indispensable auxiliary examination for patients with VA-ECMO support treatment.The recovery of hemodynamics can be used as an important indicator for offline treatment of VA-ECMO support treatment,which can more accurately evaluate the treatment effect of patients.

关 键 词：体外膜肺氧合 超声动态监测 血流动力学 静脉动脉体外膜肺氧合 

分 类 号：R445.1[医药卫生—影像医学与核医学]