超声监测下腔静脉塌陷率在评估老年患者气管插管前容量状态中的价值

发布时间：2018-04-02 19:00

  本文选题：老年患者　切入点：气管插管　出处：《南京医科大学学报(自然科学版)》2017年07期

【摘要】：目的:对需要气管插管的老年患者在麻醉诱导前按照血压常规输液,或在经胸超声监测下腔静脉塌陷率(IVC-CI)指导下行液体治疗,比较两组在低血压、氧代谢障碍发生率方面的差异。方法:气管插管机械通气的老年患者60例,随机分为两组,每组30例。插管诱导前均记录心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、氧合指数(P/F)、中心静脉氧饱和度(ScvO_2)、中心静脉-动脉二氧化碳分压差(Pcv-aCO_2)。对照组在MAP65 mmHg时给予500 mL平衡盐溶液15 min内快速静脉滴注;在MAP≥65 mmHg时不给予液体输注。实验组彩超测量下腔静脉直径(dIVC),根据公式计算IVC-CI,在IVC-CI≥50%给予500 mL平衡盐溶液15 min内快速静脉滴注;IVC-CI50%,不给予液体输注。麻醉诱导后均再次记录HR、MAP、CVP、P/F、ScvO_2、Pcv-aCO_2。结果:实验组患者血压在诱导前后没有明显变化(P0.05),但是患者的心率降低,CVP、P/F、ScvO_2增高(P0.05),差异均具有统计学意义。对照组患者诱导后血压降低、P/F增高(P0.05),差异均具有统计学意义,HR、CVP、ScvO_2差异无统计学意义(P0.05)。不论是实验组还是对照组,Pcv-aCO_2虽然都有下降,但均不具有统计学意义(P0.05)。结论:超声监测下腔静脉塌陷率评估容量相对于传统的容量评估方法,具有快速、准确、不增加患者风险的优点。
[Abstract]:Objective: to compare the hypotension between the two groups in elderly patients who need tracheal intubation before anesthesia induction according to routine infusion of blood pressure or under the guidance of IVC-CI under the monitoring of vena cava collapse rate by transthoracic ultrasound.Differences in the incidence of oxygen metabolism disorders.Methods: 60 elderly patients with mechanical ventilation were randomly divided into two groups, 30 cases in each group.Heart rate (HR), mean arterial pressure (map), central venous pressure (CVP), oxygenation index (P / F), central venous oxygen saturation (scvO _ 2), central veno-arterial CO _ 2 partial pressure difference (Pcv-aCO _ 2) were recorded before intubation induction.The control group was given 500ml equilibrium salt solution intravenously for 15 min at MAP65 mmHg, and no infusion of liquid at MAP 鈮，

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