CAJ | 학술논문

目的：探讨阻抗心动描记法（ ICG）在感染性休克患者早期目标导向治疗（ EGDT）中的应用。方法选择2013年1月—2015年3月重症医学科住院治疗的感染性休克患者68例作为研究对象，在ICG监测下进行EGDT，比较0 h、6 h血流动力学参数；根据6 h时EGDT是否达到复苏目标，分为达标组（46例）和未达标组（22例），比较2组心率（HR）、平均动脉压（MAP）、心排血量（CO）、心脏指数（CI）、每搏心排出量（SV）、心搏指数（SVI）、加速指数（ ACI）（心脏收缩时血流在主动脉内最大加速度）、左心室射血分数（ LVEF）、系统外周阻力（ SVR）、系统外周阻力指数（ SVRI）（反映外周血管阻力）、病死率；分析中心静脉血氧饱和度（ ScvO2）与血流动力学参数的相关性。结果与治疗0 h比较EGDT治疗6 h患者CO、CI、SV、SVI、SVR、SVRI显著升高，HR显著降低（ P ＜0 B．05），而LVEF、ACI无显著变化（ P ＞0．05）。达标组初始ScvO2、CO、CI、SV、SVI、LVEF、ACI显著高于未达标组，CVP、SVR、SVRI显著低于未达标组（ P ＜0．05）。未达标组病死率（72．7％）显著高于达标组（41．3％）（χ2＝5．883， P ＜0．05）。根据Spearman相关分析得出ScvO2与CO、CI、SV、SVI均呈正相关（ r ＝0．670、0．717、0．581、0．568， P ＜0．05）。结论 ICG监护系统能指导EGDT治疗，提高EGDT达标率，降低病死率。
목적：탐토조항심동묘기법（ ICG）재감염성휴극환자조기목표도향치료（ EGDT）중적응용。방법선택2013년1월—2015년3월중증의학과주원치료적감염성휴극환자68례작위연구대상，재ICG감측하진행EGDT，비교0 h、6 h혈류동역학삼수；근거6 h시EGDT시부체도복소목표，분위체표조（46례）화미체표조（22례），비교2조심솔（HR）、평균동맥압（MAP）、심배혈량（CO）、심장지수（CI）、매박심배출량（SV）、심박지수（SVI）、가속지수（ ACI）（심장수축시혈류재주동맥내최대가속도）、좌심실사혈분수（ LVEF）、계통외주조력（ SVR）、계통외주조력지수（ SVRI）（반영외주혈관조력）、병사솔；분석중심정맥혈양포화도（ ScvO2）여혈류동역학삼수적상관성。결과여치료0 h비교EGDT치료6 h환자CO、CI、SV、SVI、SVR、SVRI현저승고，HR현저강저（ P ＜0 B．05），이LVEF、ACI무현저변화（ P ＞0．05）。체표조초시ScvO2、CO、CI、SV、SVI、LVEF、ACI현저고우미체표조，CVP、SVR、SVRI현저저우미체표조（ P ＜0．05）。미체표조병사솔（72．7％）현저고우체표조（41．3％）（χ2＝5．883， P ＜0．05）。근거Spearman상관분석득출ScvO2여CO、CI、SV、SVI균정정상관（ r ＝0．670、0．717、0．581、0．568， P ＜0．05）。결론 ICG감호계통능지도EGDT치료，제고EGDT체표솔，강저병사솔。
Objective To investigate the application of impedance cardiography ( ICG) in early goal directed therapy (EGDT) of patients with septic shock.Methods Selected from January 2013 to March 2015, the ICU hospitalized patients with septic shock (68 cases) as the research subject, received the EGDT under the monitoring of ICG, compared the hemody-namic parameters at 0 h and 6 h;according to the 6 h EGDT was achieving the recovery goal or not, patients were divided into sufficiently resuscitated group (46 cases) and insufficiently resuscitated group (22 cases), the 2 groups’ heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), cardiac index (CI),stroke volume (SV),stroke volume index (SVI), acceleration index ( ACI ) ( systolic blood flow in the aorta of maximum acceleration ) , left ventricular ejection fraction (LVEF), peripheral resistance (SVR), peripheral resistance index (SVRI) (reflecting the peripheral vascular resistance), mortality rate were compared;analyzed the correlation between central venous oxygen saturation ( ScvO2 ) and hemodynamic parameters.Results Compared with treatment of 0 h, after 6 h EGDT treatment, patients’ CO, CI, SV, SVI, SVR, SVRI significantly increased, HR decreased significantly ( P <0.05) and LVEF, ACI without significant changes ( P >0.05).At initial of sufficiently resuscitated group, ScvO2 , Co, CI, SV, SVI, LVEF, ACI was significantly higher than that in the insuf-ficiently resuscitated group, CVP and SVR, SVRI was significantly lower than that of insufficiently resuscitated group ( P <0.05).Insufficiently resuscitated group’s mortality rate (72.7%) was significantly higher than that of sufficiently resuscita-ted group (41.3%) (χ2 =5.883, P <0.05).The Spearman correlation analysis showed that ScvO2 and CO, CI, SV, SVI were positively correlated ( r =0.670, r =0.717, r =0.581, r =0.568, P <0.05).Conclusion ICG monitoring system can guide the treatment of EGDT, improve the EGDT compliance rate, reduce the mortality rate.