超声心动图指导心脏术后患者容量管理的研究

发布时间：2018-10-16 11:17

【摘要】：目的:研究超声心动图指导心脏术后患者容量管理的临床效果。方法:选取2016年7月-2016年12月我院心外ICU收治的79例成人心脏病术后循环不稳的患者。将入选患者随机分为超声心动图指导容量管理组(A组)、常规容量管理组(B组)及脉波指示剂连续心排血量法(Pi CCO)指导容量管理组(C组)。记录治疗前(T0)、治疗开始后第4小时(T1)、第12小时(T2)、第24小时(T3)、第48小时(T4)3组患者的循环灌注指标;T0、T4时的心功能指标及预后。结果:与B组相比,A组T1、T2时的循环灌注指标明显改善(P0.05),T4时动脉血BNP浓度下降(P0.05);并发症发生率、机械通气时间及ICU住院时间均下降(P0.05),但28天死亡率无统计学差异;与C组相比,A组所有指标无统计学差异。结论:超声心动图用于指导心脏术后患者容量管理,可良好维持机体血流动力学稳定及脏器灌注,改善心肺功能,降低并发症发生率,与Pi CCO指导容量管理方案临床效果无差异。
[Abstract]:Objective: to study the clinical effect of echocardiography guiding volume management after cardiac surgery. Methods: from July 2016 to December 2016, 79 patients with postoperative circulatory instability of adult heart disease were treated with extracardiac ICU in our hospital. The patients were randomly divided into echocardiographic guided volume management group (group A), routine volume management group (group B) and pulse indicator continuous cardiac output method (Pi CCO) to guide volume management group (group C). Before treatment (T0), 4 hours after treatment (T1), 12 hours (T2), 24 hours (T3), 48 hours (T4), the indexes of cardiac function and prognosis were recorded. Results: compared with group B, the circulatory perfusion index of group A was significantly improved at T _ 1 and T _ 2 (P0.05), the concentration of BNP in arterial blood decreased at T _ 4 (P0.05), the incidence of complications, the duration of mechanical ventilation and the hospitalization time of ICU were all decreased (P0.05), but there was no significant difference in the death rate of 28 days. There was no statistical difference in all indexes between group A and group C. Conclusion: echocardiography can be used to guide the volume management of patients after cardiac surgery, which can maintain the stability of hemodynamics and organ perfusion, improve cardiopulmonary function and reduce the incidence of complications. There was no difference between the clinical effect of volume management and Pi CCO guidance.
【作者单位】：广东省高州市人民医院心外科ICU;
【分类号】：R540.45;R654.2

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