胸阻抗法无创血流动力学监测在心肺复苏治疗中的意义

发布时间：2018-12-05 20:44

【摘要】：目的：探讨胸阻抗法无创血流动力学监测在心肺复苏自主循环恢复的治疗中对血管活性药物应用的指导作用，以及对心肺复苏后患者脏器功能的保护意义。方法：选取2012年1月-2012年12月期间与我院住院治疗患者，既往无器质性心脏病变及心功能障碍的突发心脏骤停，经积极抢救后自主循环恢复且存活超过72小时患者13例。入选病例随机分为实验组及对照组，实验组7例，对照组6例,各组病例在性别、年龄、体重方面差异无统计学意义，且与抢救治疗同时积极治疗原发病。实验组根据胸阻抗法无创血流动力学监测仪器测定CO值调整血管活性药物的应用时间及剂量，对照组根据外周血压的变化按常规方法调整血管活性药物应用时间及剂量。各组均分别留取0分钟、1h、6h、12h、24h，48h、72h监测的CO、CI、SV、SI、ACI、VI、LVET、STR、PEP值；同时于各时间点留取静脉血经干化学法行化验检查留取CK、CK-MB、hs-TnI及BNP值，留取动脉血于床旁血气分析仪留取血LAC值;行床旁CVP检查留取CVP值，并进行GCS评分以评估患者脑神经功能恢复情况。结果：0min实验组及对照组数据监测均无明显统计学差异；1h实验组心率（HR）较对照组减少，P＜0.05,有统计学差异；6h、12h、24h、48h及72h实验组CO、CI、SV、SI、ACI、VI均高于对照组，P＜0.05，有统计学差异；12h、24h、48h及72h实验组LVET较对照组提高，P＜0.05，有统计学差异；6h、12h、24h、48h及72h实验组STR较对照组缩短，P＜0.05，有统计学差异；24h实验组PEP较对照组缩短，P0.05，有统计学差异；6h实验组CK较对照组减少，P＜0.05，有统计学差异；6h、12h、24h、48h及72h实验组CK-MB及hs-TnI与对照组比较，P0.05，无统计学差异。24h、48h、72h实验组BNP较对照组减少，P＜0.05，有统计学差异；6h、12h、24h、48h及72h实验组LAC较对照组减少，P＜0.05，有统计学差异；12h、24h、48h及72h实验组CVP较对照组减少，P＜0.05，有统计学差异；12h、24h、48h及72h实验组GCS较对照组提高，P＜0.05，有统计学差异。结论：胸阻抗法无创血流动力学动态监测可以有效指导心脏骤停后心肺复苏过程中血管活性药物的应用，可以增加心脏供血，加速缺血缺氧受损心肌细胞的恢复，增加心肌射血功能，增加患者心排出量，减轻心衰程度，，促进心功能的恢复；增加脑血流供应，减少脑组织缺血时间，降低缺血再灌注时间，减少脑组织缺血再灌注损伤，保护脑神经细胞，促进患者脑功能的恢复；尽早降低血乳酸水平，减轻组织缺氧，有利于机体氧代谢的平衡和内环境的稳定，对心肺复苏后患者脏器功能的保护有重要意义。促进患者预后恢复。
[Abstract]:Objective: to investigate the guiding role of noninvasive hemodynamic monitoring in the treatment of spontaneous circulation recovery of cardiopulmonary resuscitation (CPR) and the significance of protecting organ function after cardiopulmonary resuscitation (CPR) in patients with cardiopulmonary resuscitation (CPR). Methods: from January 2012 to December 2012, 13 patients with sudden cardiac arrest without organic heart disease and cardiac dysfunction were selected. After active rescue, the spontaneous circulation recovered and survived for more than 72 hours. The patients were randomly divided into two groups: experimental group (n = 7) and control group (n = 6). There was no significant difference in sex, age and body weight between each group. The experimental group adjusted the time and dose of vasoactive drugs according to the noninvasive hemodynamic monitoring instrument of thoracic impedance method, and the control group adjusted the time and dose of vasoactive drugs according to the changes of peripheral blood pressure. The CO,CI,SV,SI,ACI,VI,LVET,STR,PEP values of each group were taken for 0 min, 1 h, 6 h, 12 h, 24 h, 48 h and 72 h, respectively. At the same time, the venous blood was collected at each time point by dry chemical method. The values of CK,CK-MB,hs-TnI and BNP were collected by laboratory examination, and the values of LAC were collected from arterial blood by the blood gas analyzer beside the bed. Bedside CVP was performed to measure the CVP value and GCS score was used to evaluate the recovery of cerebral nerve function. Results: there was no significant difference in monitoring data between the 0min group and the control group, and the heart rate (HR) in the experimental group was lower than that in the control group at 1 h (P < 0.05). The CO,CI,SV,SI,ACI,VI of the experimental group was significantly higher than that of the control group (P < 0.05), and the LVET of the experimental group was significantly higher than that of the control group (P < 0.05). The STR of the experimental group was shorter than that of the control group (P < 0.05), the PEP of the experimental group was shorter than that of the control group (P < 0.05), and the PEP of the experimental group at 24 h was shorter than that of the control group (P 0.05). The CK of the experimental group was significantly lower than that of the control group at 6 h (P < 0.05). There was no significant difference in CK-MB and hs-TnI between the experimental group and the control group at 12 and 72 hours (P < 0.05), but the BNP in the experimental group was lower than that in the control group at 24 h and 48 h and 72 h (P < 0.05), there was statistical difference between the experimental group and the control group (P < 0.05). The LAC of the experimental group was significantly lower than that of the control group (P < 0.05), and the CVP of the experimental group was lower than that of the control group (P < 0.05) at 24 h and 72 h, respectively. The GCS of the experimental group was significantly higher than that of the control group at 24 h and 72 h (P < 0.05). Conclusion: Non-invasive dynamic monitoring of hemodynamics by thoracic impedance method can effectively guide the application of vasoactive drugs during cardiopulmonary resuscitation after cardiac arrest, increase the blood supply to the heart and accelerate the recovery of myocardial cells damaged by ischemia and hypoxia. Increase myocardial ejection function, increase cardiac output, reduce heart failure, promote the recovery of cardiac function; Increase cerebral blood flow, reduce cerebral ischemia time, reduce ischemia-reperfusion time, reduce cerebral ischemia reperfusion injury, protect brain nerve cells, promote the recovery of brain function. Reducing blood lactic acid level and tissue hypoxia as early as possible is beneficial to the balance of oxygen metabolism and stability of internal environment. It is of great significance for the protection of organ function after cardiopulmonary resuscitation (CPR). To promote the recovery of prognosis.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R459.7

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