中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2012年
2期
107-110
,共4页
陈荣琳%曹枫%刘先福%何茹
陳榮琳%曹楓%劉先福%何茹
진영림%조풍%류선복%하여
低血容量%机械通气%液体复苏%静脉压力阶差
低血容量%機械通氣%液體複囌%靜脈壓力階差
저혈용량%궤계통기%액체복소%정맥압력계차
Hypovolemia%Mechanical ventilation%Fluid resuscitation%Venous pressure gradient
目的 探讨低血容量并机械通气患者进行液体复苏时,中心静脉压(CVP)和髂总静脉压(IVP)形成的静脉压力阶差[D(c-i)VP]随液体复苏的变化,及其对循环血容量恢复是否有评估价值.方法 30例需机械通气的低血容量成年患者,在保持相似通气条件下,首先输入250 ml乳酸林格液(LR),如低血容量状态未纠正则继续输入LR,直至平均动脉压(MAP)≥65 mm Hg(1 mm Hg=0.133 kPa)、CVP≥8 mmHg、脉搏有力、灌注改善(复苏终点).测量并记录输液前、输LR 250 ml后10 min及达复苏终点时3个时间点的心率(HR)、MAP、CVP、IVP、每搏量(SV)、胸腔总液量(TFC)、D(c-i)VP值,并分析输液前后D(c-i)VP与容量指标的相关性.结果 输液前、输LR 250 ml后10 min、复苏终点时,患者HR、MAP、CVP、IVP均无明显变化;而D(c-i)VP(mm Hg)明显降低(分别为4.89±1.70、2.80±1.44、2.10±1.30),SV(ml)、TFC( ml)均明显升高(SV分别为42.0±10.5、49.0±8.3、58.0±12.1;TFC分别为30.0±9.6、38.0±8.6、43.0±11.1),各时间点两两比较差异均有统计学意义(P＜0.05或P＜0.01).D(c-i)VP与TFC、SV呈显著负相关(r1=-0.580,P1=0.004;r2=-0.462,P2=0.017).结论 低血容量机械通气患者随液体复苏进行,D(c-i)VP明显降低;并与TFC、SV有良好的负相关关系.提示D(c-i)VP的监测有助于指导低血容量并机械通气患者的液体复苏.
目的 探討低血容量併機械通氣患者進行液體複囌時,中心靜脈壓(CVP)和髂總靜脈壓(IVP)形成的靜脈壓力階差[D(c-i)VP]隨液體複囌的變化,及其對循環血容量恢複是否有評估價值.方法 30例需機械通氣的低血容量成年患者,在保持相似通氣條件下,首先輸入250 ml乳痠林格液(LR),如低血容量狀態未糾正則繼續輸入LR,直至平均動脈壓(MAP)≥65 mm Hg(1 mm Hg=0.133 kPa)、CVP≥8 mmHg、脈搏有力、灌註改善(複囌終點).測量併記錄輸液前、輸LR 250 ml後10 min及達複囌終點時3箇時間點的心率(HR)、MAP、CVP、IVP、每搏量(SV)、胸腔總液量(TFC)、D(c-i)VP值,併分析輸液前後D(c-i)VP與容量指標的相關性.結果 輸液前、輸LR 250 ml後10 min、複囌終點時,患者HR、MAP、CVP、IVP均無明顯變化;而D(c-i)VP(mm Hg)明顯降低(分彆為4.89±1.70、2.80±1.44、2.10±1.30),SV(ml)、TFC( ml)均明顯升高(SV分彆為42.0±10.5、49.0±8.3、58.0±12.1;TFC分彆為30.0±9.6、38.0±8.6、43.0±11.1),各時間點兩兩比較差異均有統計學意義(P＜0.05或P＜0.01).D(c-i)VP與TFC、SV呈顯著負相關(r1=-0.580,P1=0.004;r2=-0.462,P2=0.017).結論 低血容量機械通氣患者隨液體複囌進行,D(c-i)VP明顯降低;併與TFC、SV有良好的負相關關繫.提示D(c-i)VP的鑑測有助于指導低血容量併機械通氣患者的液體複囌.
목적 탐토저혈용량병궤계통기환자진행액체복소시,중심정맥압(CVP)화가총정맥압(IVP)형성적정맥압력계차[D(c-i)VP]수액체복소적변화,급기대순배혈용량회복시부유평고개치.방법 30례수궤계통기적저혈용량성년환자,재보지상사통기조건하,수선수입250 ml유산림격액(LR),여저혈용량상태미규정칙계속수입LR,직지평균동맥압(MAP)≥65 mm Hg(1 mm Hg=0.133 kPa)、CVP≥8 mmHg、맥박유력、관주개선(복소종점).측량병기록수액전、수LR 250 ml후10 min급체복소종점시3개시간점적심솔(HR)、MAP、CVP、IVP、매박량(SV)、흉강총액량(TFC)、D(c-i)VP치,병분석수액전후D(c-i)VP여용량지표적상관성.결과 수액전、수LR 250 ml후10 min、복소종점시,환자HR、MAP、CVP、IVP균무명현변화;이D(c-i)VP(mm Hg)명현강저(분별위4.89±1.70、2.80±1.44、2.10±1.30),SV(ml)、TFC( ml)균명현승고(SV분별위42.0±10.5、49.0±8.3、58.0±12.1;TFC분별위30.0±9.6、38.0±8.6、43.0±11.1),각시간점량량비교차이균유통계학의의(P＜0.05혹P＜0.01).D(c-i)VP여TFC、SV정현저부상관(r1=-0.580,P1=0.004;r2=-0.462,P2=0.017).결론 저혈용량궤계통기환자수액체복소진행,D(c-i)VP명현강저;병여TFC、SV유량호적부상관관계.제시D(c-i)VP적감측유조우지도저혈용량병궤계통기환자적액체복소.
Objective To investigate the value of venous pressure gradient [D(c-i)VP] between central venous pressure (CVP) and iliac vein pressure (IVP) in assessing the responsiveness to volume resuscitation in hypovolemic patient undergoing mechanical ventilation.Methods Thirty hypovolemic patients undergoing mechanical ventilation,with maintenance of similar ventilation conditions,graded volume loading was performed with 250 ml Ringer lactate solution (LR) for each infusion in hypovolemic patients,until mean arterial pressure (MAP) ≥65 mm Hg (1 mm Hg =0.133 kPa),CVP≥8 mm Hg,strong pulse,perfusion improvement (recovery in the end)were reached.Before infusion,10 minutes after infusion,and at the end of recovery,the heart rate (HR),MAP,CVP,IVP,stroke volume (SV),thoracic fluid content (TFC) and D(c-i)VP were measured and recorded,the correlations between D(c-I )VP and TFC,SV before and after infusion were analyzed.Results Before infusion,10 minutes after infusion,and at the end of recovery,no significant difference was found in HR,MAP,CVP,and IVP,while D (c-i)VP (mm Hg) was obviously lowered (4.89 ± 1.70,2.80 ± 1.44,2.10± 1.30,respectively),and SV (ml) and TFC (ml)were significantly increased (SV was 42.0 ± 10.5,49.0 ± 8.3,58.0 ± 12.1,respectively; TFC was 30.0 ± 9.6,38.0 ±8.6,43.0 ± 11.1,respectively),with statistical differences (P＜0.05 or P＜0.01 ).Negative correlations were found between D(c-i)VP and TFC,SV (r1=-0.580,P1=0.004; r2=-0.462,P2=0.017).Conclusions In the course of fluid resuscitation in hypovolemic patients undergoing mechanical ventilation,the D(c-i)VP was significantly reduced with fluid resuscitation.At the same time,significant correlations between D(c-i)VP,TFC and SV were demonstrated.The measurement of D(c-i)VP could help guide fluid resuscitation in hypovolemic patients undergoing mechanical ventilation.
