CAJ | 학술논문

目的：探讨以无创超声心输出量监测（ ultrasonic cardiac output monitor，USCOM）指标指导休克患者液体复苏的作用。方法选择ICU的休克患者47例，血细胞比容达到30％以上。分为两组，常规组（ n＝22）给予积极的容量复苏，使中心静脉压（CVP）达8～12 mmHg，维持平均动脉压（MAP）≥65 mmHg，不能维持者首先应用去甲肾上腺素[＜0．1μg／（kg? min）]，必要时加用多巴酚丁胺维持[≤20μg／（kg? min）]。 USCOM组（n＝25）根据被动抬腿试验后的每搏量变化进行液体复苏，并根据体循环外周阻力指数（ SVRI）监测结果应用去甲肾上腺素调整在2000～3100 dyne? sec? cm－5? m2，根据心脏指数（ CI）、心排量（ CO）应用多巴酚丁胺调节心功能，维持MAP≥65 mmHg。观察患者液体复苏12 h后中心静脉血氧饱和度（ ScvO2）和乳酸值、机械通气时间、住ICU时间、28 d病死率。结果两组患者复苏12 h后，USCOM组患者的CVP、MAP、ScvO2水平明显高于常规组，而乳酸低于常规组，两组比较差异具有统计学意义（P＜0．05），28 d病死率比较差异无统计学意义（P＞0．05）。常规组患者的心血管活性药物使用时间为（165．4±64．7） h，明显高于USCOM组的（113．3±56．4） h，USCOM组机械通气时间（11．3±7．6）h，住ICU时间（15．6±6．3）h，与常规组比较明显缩短。结论以USCOM的指标指导休克患者液体复苏及血管活性药应用，能达到早期液体复苏组织灌注目标，可避免盲目补液，尽早脱机，缩短住ICU时间。
목적：탐토이무창초성심수출량감측（ ultrasonic cardiac output monitor，USCOM）지표지도휴극환자액체복소적작용。방법선택ICU적휴극환자47례，혈세포비용체도30％이상。분위량조，상규조（ n＝22）급여적겁적용량복소，사중심정맥압（CVP）체8～12 mmHg，유지평균동맥압（MAP）≥65 mmHg，불능유지자수선응용거갑신상선소[＜0．1μg／（kg? min）]，필요시가용다파분정알유지[≤20μg／（kg? min）]。 USCOM조（n＝25）근거피동태퇴시험후적매박량변화진행액체복소，병근거체순배외주조력지수（ SVRI）감측결과응용거갑신상선소조정재2000～3100 dyne? sec? cm－5? m2，근거심장지수（ CI）、심배량（ CO）응용다파분정알조절심공능，유지MAP≥65 mmHg。관찰환자액체복소12 h후중심정맥혈양포화도（ ScvO2）화유산치、궤계통기시간、주ICU시간、28 d병사솔。결과량조환자복소12 h후，USCOM조환자적CVP、MAP、ScvO2수평명현고우상규조，이유산저우상규조，량조비교차이구유통계학의의（P＜0．05），28 d병사솔비교차이무통계학의의（P＞0．05）。상규조환자적심혈관활성약물사용시간위（165．4±64．7） h，명현고우USCOM조적（113．3±56．4） h，USCOM조궤계통기시간（11．3±7．6）h，주ICU시간（15．6±6．3）h，여상규조비교명현축단。결론이USCOM적지표지도휴극환자액체복소급혈관활성약응용，능체도조기액체복소조직관주목표，가피면맹목보액，진조탈궤，축단주ICU시간。
Objective To explore ultrasonic cardiac output monitor ( USCOM) indicators to guide fluid resuscitation in pa-tients with shock.Methods ICU patients with shock of 47 cases were divided into two groups.Hematocrit of two groups are more than 30%.Routine group (n=25) give a positive volume resuscitation, so central venous pressure (CVP) up to 8-12 mmHg, mean arte-rial pressure≥65 mmHg, which can not maintain use norepinephrine [<0.1μg/(kg? min)], if necessary dobutamine maintain [≤20 μg/( kg? min) ] .In USCOM group ( n=25) , according to the change stroke volume which measured passive leg test get on fluid resuscitation and according to circulation peripheral resistance index ( SVRI) monitoring results to adjust the application of nore pineph-rine in 2000-3100 dyne? sec? cm-5? m2, according to the heart index (CI), cardiac output (CO) dobutamine regulate heart func-tion, maintain mean arterial pressure≥65 mmHg.The central venous oxygen saturation and lactate levels were observed in patients after 12 hours, duration of mechanical ventilation, ICU stay, 28 d mortality.Results USCOM group central venous pressure (CVP), main-tain mean arterial pressure ( MAP) , central venous oxygen saturation ( ScvO2 ) levels were significantly higher than the routine group after resuscitation 12 hours, while lactic acid was lower than the routine group, the difference was statistically significant (P<0.05).28 d mortality difference was not statistically significant (P>0.05).Routine group patients with cardiovascular activity duration of drug use was (165.4 ±64.7) hours, was significantly higher than that of USCOM group (113.3 ±56.4) hours.USCOM group mechanical ven-tilation time was (11.3 ±7.6) hours, ICU time was (15.6 ±6.3) hours, which was obviously reduced comparing with conventional group.Conclusion USCOM indicators to guide fluid resuscitation in patients with shock and cardiovascular drug use can reach the target tissue perfusion of early fluid resuscitation, while avoiding blind rehydration, as soon as off ventilator, shorten ICU stay.