床旁心肺超声在ICU心脏术后患者早期液体评估中的临床研究  

Clinical application of bedside cardiopulmonary ultrasound in early fluid resuscitation of ICU patients after cardiac surgery

作　　者：陈秀芹[1] 吴泳锐 康婉 李梅 孙蒙奇 李想 韩鑫 CHEN Xiuqin;WU Yongrui;KANG Wan;LI Mei;SUN Mengqi;LI Xiang;HAN Xin(Department of Critical Care Medicine,People′s Hospital of Taihe County,Taihe 236600,Anhui,China)

机构地区：[1]太和县人民医院重症医学科,安徽太和236600 [2]太和县人民医院超声医学科,安徽太和236600

出　　处：《皖南医学院学报》2024年第2期201-204,共4页Journal of Wannan Medical College

基　　金：阜阳市卫生健康委科研立项课题(FY2021-164)。

摘　　要：目的:探究床旁心肺超声在心脏术后患者早期液体评估中的临床应用价值。方法:选择2020年1月~2022年12月太和县人民医院收治的82例心脏外科手术患者为研究对象,按照随机数字表法分为观察组(n=41)和对照组(n=41)。两组患者术后均给予标准化治疗,对照组根据中心静脉压指导早期补液,观察组则基于床旁心肺超声指导患者早期补液,对比两组患者术后24 h基础生命体征指标、心功能指标及补液量变化,跟踪记录两组患者的机械通气时间、血管活性药物使用时间及ICU住院时间,随访1个月对比两组患者的预后情况。结果:观察组患者术后24 h时的心率、呼吸频率及补液量均低于对照组(P<0.05),平均动脉压高于对照组(P<0.05);观察组术后机械通气时间、血管活性药物使用时间及ICU住院时间均短于对照组(P<0.05);观察组术后无二次手术病例,对照组1例二次手术,观察组术后1个月无死亡病例,对照组术后1个月1例患者死亡。结论:心肺联合超声目标导向液体管理在ICU心脏术后患者中应用效果良好,其有助于减少心脏术后患者术后输液量及缩短机械通气时间、血管活性药物使用时间及ICU住院时间。Objective:To assess the clinical value of applying bedside cardiopulmonary ultrasound in early fluid assessment in patients after cardiac surgery.Methods:Eighty-two post-cardiac surgery patients admitted to our hospital were included from January 2020 to December 2022,and randomly divided into observational group(n=41)and control group(n=41)using the random number table method.All patients received standardized treatment after surgery.Early fluid resuscitation was implemented based on the patient′s central venous pressure in the control group and bedside cardiopulmonary ultrasound in the observational group.Two groups were compared regarding vital signs,cardiac function indicators and fluid replacement volume within 24 hours after surgery.The mechanical ventilation time,duration of vasopressor use and length of ICU stay were recorded and follow-up was conducted for one month to compare the prognosis of patients in two groups.Results:The heart rate,respiratory rate and fluid replacement volume of patients in the observational group at 24 hours after surgery were significantly lower than those of the control group(P<0.05),and the mean arterial pressure was significantly higher(P<0.05).The observational group had significantly shorter mechanical ventilation time,duration of vasopressor use and length of ICU stay(P<0.05).There was no case of reoperation in the observational group,whereas reoperation was required in one case in the control group.No death occurred at one-month follow-up in the observational group,yet there was one death in the control group.Conclusion:Bedside cardiopulmonary ultrasound-guided fluid management shows promising efficacy in post-operative cardiac surgery patients in ICU,which helps to reduce fluid replacement volume and shorten mechanical ventilation time,duration of vasopressor use and length of ICU stay.

关 键 词：床旁心肺超声 重症监护病房 心脏手术 早期液体评估 

分 类 号：R473.6[医药卫生—护理学] R445.1[医药卫生—临床医学]