CAJ | 학술논문

目的：研究超声心输出量监测仪（USCOM ）对肺挫伤致急性呼吸窘迫综合征（ARDS）患者的液体管理在临床工作中的指导作用。方法选取30例肺挫伤致 ARDS的患者作为研究对象，随机分为实验组和对照组各15例，实验组通过 US-COM监测指导患者的液体管理，对照组通过监测中心静脉压（CVP）指导液体管理，比较两组患者入住ICU后24、48、72 h的液体出入量，第1、2、3、5、7天的动脉血乳酸（Lac）、氧合指数（OI），血管活性药物使用时间，呼吸机使用时间及28天死亡率。结果两组患者入住IC U后24、48及72 h净入量比较比较差异均无统计学意义。经治疗后两组患者的动脉血乳酸随时间变化均呈下降趋势，第5天的氧合指数比较差异有统计学意义，实验组患者氧合指数改善较对照组患者更早。两组患者去甲肾上腺素使用时间比较差异无统计学意义。两组患者呼吸机使用时间比较，实验组患者呼吸机使用时间较对照组患者缩短。结论 USCOM监测指导的肺挫伤致ARDS患者的液体管理，可以更早的改善患者的氧合指数，缩短呼吸机的使用时间，但还不能降低患者28天的死亡率。
목적：연구초성심수출량감측의（USCOM ）대폐좌상치급성호흡군박종합정（ARDS）환자적액체관리재림상공작중적지도작용。방법선취30례폐좌상치 ARDS적환자작위연구대상，수궤분위실험조화대조조각15례，실험조통과 US-COM감측지도환자적액체관리，대조조통과감측중심정맥압（CVP）지도액체관리，비교량조환자입주ICU후24、48、72 h적액체출입량，제1、2、3、5、7천적동맥혈유산（Lac）、양합지수（OI），혈관활성약물사용시간，호흡궤사용시간급28천사망솔。결과량조환자입주IC U후24、48급72 h정입량비교비교차이균무통계학의의。경치료후량조환자적동맥혈유산수시간변화균정하강추세，제5천적양합지수비교차이유통계학의의，실험조환자양합지수개선교대조조환자경조。량조환자거갑신상선소사용시간비교차이무통계학의의。량조환자호흡궤사용시간비교，실험조환자호흡궤사용시간교대조조환자축단。결론 USCOM감측지도적폐좌상치ARDS환자적액체관리，가이경조적개선환자적양합지수，축단호흡궤적사용시간，단환불능강저환자28천적사망솔。
Objective To study the guiding role of ultrasonic cardiac output monitor (USCOM ) in fluid management of ARDS patients induced by pulmonary contusion .Methods A total of 30 ARDS patients induced by pulmonary contusion were random-ly divided into the experimental group and the control group (n=15 each) ,and the experimental group was given the fluid man-agement according to USCOM ,and the control group according to CVP .Liquid intake and output volumes after 24 ,48 and 72 h were calculated .Arterial blood lactic acid and oxygenation index were measured at 1th ,2th ,3th ,5th and 7th day .Patients were followed until time of hospital discharge to determine hours of mechanical ventilation ,hours of vasoactive agent support and 28 d mortality .Results There were no statistical difference in the liquid balance volume of intake and output between the two groups after 24 ,48 and 72 h .statistical difference was found in oxygenation index between the two groups at 5th day .Oxygena-tion index improved earlier in the USCOM group .Hours of mechanical ventilation of the USCOM group was significantly shor-ter than the patients'of the CVP group ,however ,there was no statistical difference between the two groups in hours of vasoac-tive agent support .Conclusions The fluid management using USCOM can earlier improve the oxygenation index and shorten duration of mechanical ventilation ,but can't significantly decrease the 28 d mortality rate of ARDS patients induced by pulmona-ry contusion .