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[1]郭春文,闫 红,黄阿勤.无创超声心输出量监测在休克早期复苏中的指导作用[J].医学研究与战创伤救治(原医学研究生学报),2015,17(03):263-265.[doi:10.3969/j.issn.1672-271X.2015.03.012]
　GUO Chun-wen,YAN Hong,HUANG A-qin..Guiding role of ultrasound cardiac output monitor in early shock resuscitation[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2015,17(03):263-265.[doi:10.3969/j.issn.1672-271X.2015.03.012]
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无创超声心输出量监测在休克早期复苏中的指导作用()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第17卷
期数:
2015年03期
页码:
263-265
栏目:
出版日期:
2015-05-20

文章信息/Info

Title:
Guiding role of ultrasound cardiac output monitor in early shock resuscitation
作者:
郭春文; 闫 红; 黄阿勤
362000 福建泉州，解放军180医院重症医学科
Author(s):
GUO Chun-wen;  YAN Hong;  HUANG A-qin.
180 Hospital of PLA， Quanzhou， Fujian 362000， China
关键词:
超声心输出量监测; 休克; 复苏
Keywords:
ultrasonic cardiac output monitor;  shock;  resuscitation
分类号:
R641
DOI:
10.3969/j.issn.1672-271X.2015.03.012
文献标志码:
A
摘要:
目的 探讨以无创超声心输出量监测（ultrasonic cardiac output monitor，USCOM）指标指导休克患者液体复苏的作用。方法 选择ICU的休克患者47例，血细胞比容达到30%以上。分为两组，常规组(n=22)给予积极的容量复苏，使中心静脉压(CVP)达8～12 mmHg，维持平均动脉压（MAP）≥65 mmHg，不能维持者首先应用去甲肾上腺素[＜0.1 μg/(kg·min)]，必要时加用多巴酚丁胺维持[≤20 μg/(kg·min)]。USCOM组(n=25)根据被动抬腿试验后的每搏量变化进行液体复苏，并根据体循环外周阻力指数(SVRI)监测结果应用去甲肾上腺素调整在2000～3100 dyne·sec·cm-5·m2，根据心脏指数(CI)、心排量(CO)应用多巴酚丁胺调节心功能，维持MAP≥65 mmHg。观察患者液体复苏12 h后中心静脉血氧饱和度（ScvO2）和乳酸值、机械通气时间、住ICU时间、28 d病死率。结果 两组患者复苏12 h后，USCOM组患者的CVP、MAP、ScvO2水平明显高于常规组，而乳酸低于常规组，两组比较差异具有统计学意义(P<0．05)，28 d病死率比较差异无统计学意义(P>0.05)。常规组患者的心血管活性药物使用时间为(165.4±64.7) h，明显高于USCOM组的(113.3±56.4)h，USCOM组机械通气时间(11.3±7.6)h，住ICU时间(15.6±6.3)h，与常规组比较明显缩短。结论 以USCOM的指标指导休克患者液体复苏及血管活性药应用，能达到早期液体复苏组织灌注目标，可避免盲目补液，尽早脱机，缩短住ICU时间。
Abstract:
Objective To explore ultrasonic cardiac output monitor (USCOM) indicators to guide fluid resuscitation in patients with shock. Methods ICU patients with shock of 47 cases were divided into two groups. Hematocrit of two groups are more than 30%. Routine group (n=25) give a positive volume resuscitation， so central venous pressure (CVP) up to 8-12 mmHg， mean arterial pressure ≥65 mmHg， which can not maintain use norepinephrine [<0.1 μg/(kg·min)]， if necessary dobutamine maintain [≤20 μg/(kg·min)]. In USCOM group (n=25)， according to the change stroke volume which measured passive leg test get on fluid resuscitation and according to circulation peripheral resistance index (SVRI) monitoring results to adjust the application of nore pinephrine in 2000-3100 dyne·sec·cm-5·m2， according to the heart index (CI)， cardiac output (CO) dobutamine regulate heart function， maintain mean arterial pressure ≥65 mmHg. The central venous oxygen saturation and lactate levels were observed in patients after 12 hours， duration of mechanical ventilation， ICU stay， 28 d mortality. Results USCOM group central venous pressure (CVP)， maintain mean arterial pressure (MAP)， central venous oxygen saturation (ScvO2) levels were significantly higher than the routine group after resuscitation 12 hours， while lactic acid was lower than the routine group， the difference was statistically significant (P<0.05). 28 d mortality difference was not statistically significant (P>0.05). Routine group patients with cardiovascular activity duration of drug use was （165.4±64.7） hours， was significantly higher than that of USCOM group (113.3±56.4) hours. USCOM group mechanical ventilation time was （11.3±7.6） hours， ICU time was （15.6±6.3） hours， which was obviously reduced comparing with conventional group. Conclusion USCOM indicators to guide fluid resuscitation in patients with shock and cardiovascular drug use can reach the target tissue perfusion of early fluid resuscitation， while avoiding blind rehydration， as soon as off ventilator， shorten ICU stay.

参考文献/References:

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备注/Memo

备注/Memo:
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更新日期/Last Update: 2015-05-20