CAJ | 학술논문

目的：分析感染性休克患者中血管活性药物的应用对血流动力学的影响，探讨系统血管阻力指数（SVRI）对血管活性药物应用的指导价值。方法回顾性分析2010年3月至2012年4月入住该院重症医学科的感染性休克患者21例，应用PiC-CO技术监测其心脏指数（CI）、胸腔内血容量指数（ITBI）、系统血管阻力指数（SVRI）及平均动脉压（MAP），每6～8小时监测一次。以ITBI＞850 mL/m2作为容量正常的标准，收集所有符合标准的患者数据共202例。以MAP是否大于65 mm Hg作为分组标准（MAP＜65 mm Hg组，MAP≥65 mm Hg组），比较两组数据血流动力学参数的差异性，在MAP≥65 mm Hg组中根据SVRI的不同分为3组（1、2、3组），比较不同SVRI组时血压、心功能及容量的特点。结果 MAP＜65 mm Hg组和MAP≥65 mm Hg组的ITBI均高于正常值，MAP≥65 mm Hg组的CI、SVRI值均高于MAP＜65 mm Hg组（P＜0．05），而ITBI在两组中差异无统计学意义。MAP≥65 mm Hg组根据SVRI的不同分为的3组，所有例数中ITBI都高于正常上限，且3组比较时，仅1、3组比较差异有统计学意义（P＝0．47）。SVRI低下时，CI高于正常值，随着SVRI的增加，MAP逐步增高，CI逐步下降，当SVRI过高时，MAP无明显增加，而CI值低于下限。结论对感染性休克患者进行SVRI监测，有助于指导血管活性药物的应用，其低下时提示血管反应性下降，过高时提示心功能低下，且过度收缩血管并不能进一步提升血压。
목적：분석감염성휴극환자중혈관활성약물적응용대혈류동역학적영향，탐토계통혈관조력지수（SVRI）대혈관활성약물응용적지도개치。방법회고성분석2010년3월지2012년4월입주해원중증의학과적감염성휴극환자21례，응용PiC-CO기술감측기심장지수（CI）、흉강내혈용량지수（ITBI）、계통혈관조력지수（SVRI）급평균동맥압（MAP），매6～8소시감측일차。이ITBI＞850 mL/m2작위용량정상적표준，수집소유부합표준적환자수거공202례。이MAP시부대우65 mm Hg작위분조표준（MAP＜65 mm Hg조，MAP≥65 mm Hg조），비교량조수거혈류동역학삼수적차이성，재MAP≥65 mm Hg조중근거SVRI적불동분위3조（1、2、3조），비교불동SVRI조시혈압、심공능급용량적특점。결과 MAP＜65 mm Hg조화MAP≥65 mm Hg조적ITBI균고우정상치，MAP≥65 mm Hg조적CI、SVRI치균고우MAP＜65 mm Hg조（P＜0．05），이ITBI재량조중차이무통계학의의。MAP≥65 mm Hg조근거SVRI적불동분위적3조，소유례수중ITBI도고우정상상한，차3조비교시，부1、3조비교차이유통계학의의（P＝0．47）。SVRI저하시，CI고우정상치，수착SVRI적증가，MAP축보증고，CI축보하강，당SVRI과고시，MAP무명현증가，이CI치저우하한。결론대감염성휴극환자진행SVRI감측，유조우지도혈관활성약물적응용，기저하시제시혈관반응성하강，과고시제시심공능저하，차과도수축혈관병불능진일보제승혈압。
Objective To analyze the influence of vasoactive drugs on hemodynamics in septic shock patients and to explore the guiding value of systemic vascular resistance index (SVRI) for the application of vasoactive drugs .Methods 21 cases of septic shock in ICU from March 2010 to April 2012 were retrospectively analyzed .The PiCCO monitor technique was applied to monitor the he-modynamic parameters including the cardiac index (CI) ,intrathoracic blood volume index (ITBI) ,systemic cenous resistance index (SVRI) and mean arterial pressure(MAP) ,once per 6-8 h .ITBI>850 mL/m2 was taken as the normal criterion .The data of 202 cases meeting the criterion were collected .These cases were divided into two groups according to whether MAP reach 65 mm Hg , the differences of hemodynamic parameters between the two groups were compared .The MAP≥65 mm Hg group was redivided in-to the group 1 ,2 and 3 according to SVRI .Blood characteristics of pressure ,CI and ITBI were compared among these 3 groups .Re-sults The ITBI value in the MAP<65 mm Hg group and the MAP≥65 mm Hg group was higher than the normal value .The CI and SVRI values in the MAP≥65 mm Hg group were higher than those in the MAP< 65 mm Hg group(P<0 .05) ,while the ITBI value had no difference between the two groups .The ITBI values in the three groups with different SVRI all were higher than the upper normal limit ,furthermore ,in the comparisons among 3 groups ,only comparison between the group 1 and the group 3 had sta-tistical difference(P= 0 .47) .When SVRI was lower ,the CI value was higher than the normal value .Along with the increase of SVRI ,MAP increased gradually ,and CI gradually declined .When SVRI was too high ,MAP had no significant increase ,but the CI value was lower than the lower limit .Conclusion The SVRI monitoring by PiCCO can help to guide the application of vasoactive drugs in septic shock patients ,lower SVRI means the declined vascular reaction and higher SVRI indicates the low cardiac function , moreover blood pressure can not be further enhanced by vascular excessive contraction .