无创血流动力学与热稀释法监测在急性农药中毒治疗中的应用  

Application of Noninvasive Hemodynamic Monitoring and Thermodilution Monitoring in Acute Pesticide Poisoning

作　　者：王玉凤 高珣 肖青勉 WANG Yu-feng;GAO Xun;XIAO Qing-mian(Department of Emergency Medicine,Hengshui People’s Hospital,Hengshui 053000,China)

机构地区：[1]衡水市人民医院急诊科,河北衡水053000

出　　处：《南昌大学学报（医学版）》2023年第1期34-38,54,共6页Journal of Nanchang University：Medical Sciences

基　　金：河北省卫生和计划生育委员会重点课题计划(20181568)。

摘　　要：目的 回顾性分析无创血流动力学与热稀释法监测系统在急性农药中毒患者临床治疗中的应用价值。方法 选取2019年4月至2020年7月衡水市人民医院急性农药中毒患者112例,依据监测系统不同分为无创组(使用无创血流动力学监测)与热稀释组(使用热稀释法),每组各56例。比较2组临床指标(呼吸机使用时间、胆碱酯酶活性恢复用时、生命体征监测时间、住院时间、阿托品总用量、住院费用)、治疗前及治疗(15、30、60、120和240 min)时的血药质量浓度以及治疗前、后的心功能指标[左心室做功指数(LCWI)、左心室做功(LCW)、每搏输出量(SV)、心输出量(CO)]、血流动力学指标[平均动脉压(MAP)、心率(HR)]、血气指标[血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、pH值]、不良事件发生率。结果 无创组呼吸机使用时间、胆碱酯酶活性恢复用时、生命体征监测时间、住院时间均短于热稀释组,阿托品总用量、住院费用少于热稀释组(均P<0.05);无创组治疗60、120、240 min时血药质量浓度低于热稀释组(均P<0.05);治疗结束后无创组LCWI、LCW、SV、CO水平高于热稀释组(均P<0.05);治疗240 min时、治疗结束后无创组PaO_(2)、pH值高于热稀释组,PaCO_(2)低于热稀释组(均P<0.05);无创组不良事件发生率低于热稀释组(16.33%比36.17%,P<0.05)。结论 与热稀释法比较,无创血流动力学监测系统在指导急性农药中毒患者治疗时监测效果更佳,更有利于改善患者病情,促进患者康复。Objective To explore the values of noninvasive hemodynamic monitoring and thermodilution monitoring in patients with acute pesticide poisoning.Methods A total of 112 patients with acute pesticide poisoning treated in Hengshui People’s from April 2019 to July 2020 were assigned to receive either noninvasive hemodynamic monitoring(noninvasive group,56 cases)or thermodilution monitoring(thermodilution group,56 cases).Clinical indicators(duration of mechanical ventilation,recovery time of cholinesterase activity,monitoring time of vital signs,length of hospital stay,total consumption of atropine and hospitalization costs),blood drug concentrations before treatment and after treatment for 15,30,60,120 and 240 min,cardiac function indexes[left cardiac work index(LCWI),left cardiac work(LCW),stroke volume(SV)and cardiac output(CO)],hemodynamic indexes[mean arterial pressure(MAP)and heart rate(HR)],blood gas indexes[partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2))and pH value],and incidence of adverse events were compared between the two groups.Results Compared with noninvasive hemodynamic monitoring,thermodilution monitoring shortened the duration of mechanical ventilation,recovery time of cholinesterase activity,monitoring time of vital signs and length of hospital stay,and reduced the total consumption of atropine and hospitalization costs(P<0.05).After treatment for 60,120 and 240 min,blood drug concentrations in the noninvasive group were lower than those in the thermodilution group(P<0.05).At the end of treatment,the LCWI,LCW,SV and CO in the noninvasive group were higher than those in the thermodilution group(P<0.05).After treatment for 240 min,the PaO_(2) and pH value in the noninvasive group was higher than that in the thermodilution group,and the PaCO_(2) in the noninvasive group were lower than those in the ther modilution group(P<0.05).The incidence of adverse events in the noninvasive group was lower than that in the thermodilution group(16.33%vs 36.17%)(P<0.05).Conclusion I

关 键 词：急性农药中毒 无创血流动力学监测系统 热稀释法 临床治疗 回顾性分析 

分 类 号：R459.7[医药卫生—急诊医学]