血流动力学监测群体化策略——CHOLKIT方案对心脏外科术后患者预后的价值分析  

Analysis of the prognostic value of hemodynamic monitoring collective strategy-CHOLKIT protocol in patients after cardiac surgery

作　　者：王睿 宋云林[2] 任禹澄 通耀威 居来提 王正凯[2] 李颖[2] WANG Rui;SONG Yunlin;REN Yucheng;TONG Yaowei;JU Laiti;WANG Zhengkai;LI Ying(Graduate School,Xinjiang Medical University,Urumqi 830011,Xinjiang,China;Center for Critical Care Medicine,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,Xinjiang,China)

机构地区：[1]新疆医科大学研究生学院,新疆乌鲁木齐830011 [2]新疆医科大学第一附属医院重症医学中心,新疆乌鲁木齐830011

出　　处：《中国现代医生》2024年第30期55-60,共6页China Modern Doctor

摘　　要：目的通过实施血流动力学监测群体化策略——CHOLKIT方案预测心脏外科术后患者的预后,探讨CHOLKIT方案的实际应用价值,如早期干预改善组织灌注及微循环,预测拔管时机。方法采用前瞻性队列研究分析新疆医科大学第一附属医院2020年4月至10月接受心脏外科手术的88例患者,以患者存活或死亡作为研究终点,将其分为生存组(84例)和死亡组(4例)。应用CHOLKIT方案对不同时间段患者的中心静脉压(central venous pressure,CVP)、心率(heart rate,HR)、中心静脉血氧饱和度(central venous oxygen saturation,ScvO_(2))、乳酸(lactic acid,Lac)、血钾(K^(+))、灌注指数(perfusion index,PI)和足趾温度(temperature,T)进行评分,根据评分预测CHOLKIT评分与预后的相关性。结果CHOLKIT方案中部分监测指标与心脏外科术后死亡率、肾损伤及机械通气时间相关。结论CHOLKIT方案可预估心脏外科术后患者拔管时机及病情变化,尽早干预可改善患者预后、机械通气时间及重症监护病房入住天数。Objective To predict the prognosis of patients after cardiac surgery by implementing hemodynamic monitoring collective strategy—CHOLKIT protocol,and to explore the practical application value of CHOLKIT protocol,such as early intervention to improve tissue circulation and microcirculation,and predict the timing of extubation.Methods A prospective cohort study was used to analyse 88 patients who underwent cardiac surgery in the First Affiliated Hospital of Xinjiang Medical University from April to October 2020,and they were divided into the survival group(84 cases)and the death group(4 cases)with patient survival or death as the study endpoint.The CHOLKIT protocol was applied to score the central venous pressure(CVP),heart rate(HR),central venous oxygen saturation(ScvO_(2)),lactic acid(Lac),potassium(K^(+)),perfusion index(PI),and toe temperature(T)of patients at different time periods.The correlation between CHOLKIT score and prognosis was predicted based on the scores.Results Some monitoring indexes in the CHOLKIT protocol were related to the mortality,renal injury and duration of mechanical ventilation after cardiac surgery.Conclusion The CHOLKIT protocol can predict the timing of extubation and the change of the condition of patients after cardiac surgery,and early intervention can improve the prognosis of patients,duration of mechanical ventilation and number of days of stay in the intensive care unit.

关 键 词：心脏外科术后 血流动力学监测 循环 CHOLKIT方案 

分 类 号：R604[医药卫生—外科学]