胸阻抗法無創(chuàng)血流動力學監(jiān)測在心肺復蘇治療中的意義
發(fā)布時間：2018-12-05 20:44
【摘要】：目的：探討胸阻抗法無創(chuàng)血流動力學監(jiān)測在心肺復蘇自主循環(huán)恢復的治療中對血管活性藥物應用的指導作用，以及對心肺復蘇后患者臟器功能的保護意義。 方法：選取2012年1月-2012年12月期間與我院住院治療患者，既往無器質(zhì)性心臟病變及心功能障礙的突發(fā)心臟驟停，經(jīng)積極搶救后自主循環(huán)恢復且存活超過72小時患者13例。入選病例隨機分為實驗組及對照組，實驗組7例，對照組6例,各組病例在性別、年齡、體重方面差異無統(tǒng)計學意義，且與搶救治療同時積極治療原發(fā)病。實驗組根據(jù)胸阻抗法無創(chuàng)血流動力學監(jiān)測儀器測定CO值調(diào)整血管活性藥物的應用時間及劑量，對照組根據(jù)外周血壓的變化按常規(guī)方法調(diào)整血管活性藥物應用時間及劑量。各組均分別留取0分鐘、1h、6h、12h、24h，48h、72h監(jiān)測的CO、CI、SV、SI、ACI、VI、LVET、STR、PEP值；同時于各時間點留取靜脈血經(jīng)干化學法行化驗檢查留取CK、CK-MB、hs-TnI及BNP值，留取動脈血于床旁血氣分析儀留取血LAC值;行床旁CVP檢查留取CVP值，并進行GCS評分以評估患者腦神經(jīng)功能恢復情況。 結(jié)果：0min實驗組及對照組數(shù)據(jù)監(jiān)測均無明顯統(tǒng)計學差異；1h實驗組心率（HR）較對照組減少，P＜0.05,有統(tǒng)計學差異；6h、12h、24h、48h及72h實驗組CO、CI、SV、SI、ACI、VI均高于對照組，P＜0.05，有統(tǒng)計學差異；12h、24h、48h及72h實驗組LVET較對照組提高，P＜0.05，有統(tǒng)計學差異；6h、12h、24h、48h及72h實驗組STR較對照組縮短，P＜0.05，有統(tǒng)計學差異；24h實驗組PEP較對照組縮短，P0.05，有統(tǒng)計學差異；6h實驗組CK較對照組減少，P＜0.05，有統(tǒng)計學差異；6h、12h、24h、48h及72h實驗組CK-MB及hs-TnI與對照組比較，P0.05，無統(tǒng)計學差異。24h、48h、72h實驗組BNP較對照組減少，P＜0.05，有統(tǒng)計學差異；6h、12h、24h、48h及72h實驗組LAC較對照組減少，P＜0.05，有統(tǒng)計學差異；12h、24h、48h及72h實驗組CVP較對照組減少，P＜0.05，有統(tǒng)計學差異；12h、24h、48h及72h實驗組GCS較對照組提高，P＜0.05，有統(tǒng)計學差異。 結(jié)論：胸阻抗法無創(chuàng)血流動力學動態(tài)監(jiān)測可以有效指導心臟驟停后心肺復蘇過程中血管活性藥物的應用，可以增加心臟供血，加速缺血缺氧受損心肌細胞的恢復，增加心肌射血功能，增加患者心排出量，減輕心衰程度，，促進心功能的恢復；增加腦血流供應，減少腦組織缺血時間，降低缺血再灌注時間，減少腦組織缺血再灌注損傷，保護腦神經(jīng)細胞，促進患者腦功能的恢復；盡早降低血乳酸水平，減輕組織缺氧，有利于機體氧代謝的平衡和內(nèi)環(huán)境的穩(wěn)定，對心肺復蘇后患者臟器功能的保護有重要意義。促進患者預后恢復。
[Abstract]:Objective: to investigate the guiding role of noninvasive hemodynamic monitoring in the treatment of spontaneous circulation recovery of cardiopulmonary resuscitation (CPR) and the significance of protecting organ function after cardiopulmonary resuscitation (CPR) in patients with cardiopulmonary resuscitation (CPR). Methods: from January 2012 to December 2012, 13 patients with sudden cardiac arrest without organic heart disease and cardiac dysfunction were selected. After active rescue, the spontaneous circulation recovered and survived for more than 72 hours. The patients were randomly divided into two groups: experimental group (n = 7) and control group (n = 6). There was no significant difference in sex, age and body weight between each group. The experimental group adjusted the time and dose of vasoactive drugs according to the noninvasive hemodynamic monitoring instrument of thoracic impedance method, and the control group adjusted the time and dose of vasoactive drugs according to the changes of peripheral blood pressure. The CO,CI,SV,SI,ACI,VI,LVET,STR,PEP values of each group were taken for 0 min, 1 h, 6 h, 12 h, 24 h, 48 h and 72 h, respectively. At the same time, the venous blood was collected at each time point by dry chemical method. The values of CK,CK-MB,hs-TnI and BNP were collected by laboratory examination, and the values of LAC were collected from arterial blood by the blood gas analyzer beside the bed. Bedside CVP was performed to measure the CVP value and GCS score was used to evaluate the recovery of cerebral nerve function. Results: there was no significant difference in monitoring data between the 0min group and the control group, and the heart rate (HR) in the experimental group was lower than that in the control group at 1 h (P < 0.05). The CO,CI,SV,SI,ACI,VI of the experimental group was significantly higher than that of the control group (P < 0.05), and the LVET of the experimental group was significantly higher than that of the control group (P < 0.05). The STR of the experimental group was shorter than that of the control group (P < 0.05), the PEP of the experimental group was shorter than that of the control group (P < 0.05), and the PEP of the experimental group at 24 h was shorter than that of the control group (P 0.05). The CK of the experimental group was significantly lower than that of the control group at 6 h (P < 0.05). There was no significant difference in CK-MB and hs-TnI between the experimental group and the control group at 12 and 72 hours (P < 0.05), but the BNP in the experimental group was lower than that in the control group at 24 h and 48 h and 72 h (P < 0.05), there was statistical difference between the experimental group and the control group (P < 0.05). The LAC of the experimental group was significantly lower than that of the control group (P < 0.05), and the CVP of the experimental group was lower than that of the control group (P < 0.05) at 24 h and 72 h, respectively. The GCS of the experimental group was significantly higher than that of the control group at 24 h and 72 h (P < 0.05). Conclusion: Non-invasive dynamic monitoring of hemodynamics by thoracic impedance method can effectively guide the application of vasoactive drugs during cardiopulmonary resuscitation after cardiac arrest, increase the blood supply to the heart and accelerate the recovery of myocardial cells damaged by ischemia and hypoxia. Increase myocardial ejection function, increase cardiac output, reduce heart failure, promote the recovery of cardiac function; Increase cerebral blood flow, reduce cerebral ischemia time, reduce ischemia-reperfusion time, reduce cerebral ischemia reperfusion injury, protect brain nerve cells, promote the recovery of brain function. Reducing blood lactic acid level and tissue hypoxia as early as possible is beneficial to the balance of oxygen metabolism and stability of internal environment. It is of great significance for the protection of organ function after cardiopulmonary resuscitation (CPR). To promote the recovery of prognosis.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R459.7
本文編號：2365445
[Abstract]:Objective: to investigate the guiding role of noninvasive hemodynamic monitoring in the treatment of spontaneous circulation recovery of cardiopulmonary resuscitation (CPR) and the significance of protecting organ function after cardiopulmonary resuscitation (CPR) in patients with cardiopulmonary resuscitation (CPR). Methods: from January 2012 to December 2012, 13 patients with sudden cardiac arrest without organic heart disease and cardiac dysfunction were selected. After active rescue, the spontaneous circulation recovered and survived for more than 72 hours. The patients were randomly divided into two groups: experimental group (n = 7) and control group (n = 6). There was no significant difference in sex, age and body weight between each group. The experimental group adjusted the time and dose of vasoactive drugs according to the noninvasive hemodynamic monitoring instrument of thoracic impedance method, and the control group adjusted the time and dose of vasoactive drugs according to the changes of peripheral blood pressure. The CO,CI,SV,SI,ACI,VI,LVET,STR,PEP values of each group were taken for 0 min, 1 h, 6 h, 12 h, 24 h, 48 h and 72 h, respectively. At the same time, the venous blood was collected at each time point by dry chemical method. The values of CK,CK-MB,hs-TnI and BNP were collected by laboratory examination, and the values of LAC were collected from arterial blood by the blood gas analyzer beside the bed. Bedside CVP was performed to measure the CVP value and GCS score was used to evaluate the recovery of cerebral nerve function. Results: there was no significant difference in monitoring data between the 0min group and the control group, and the heart rate (HR) in the experimental group was lower than that in the control group at 1 h (P < 0.05). The CO,CI,SV,SI,ACI,VI of the experimental group was significantly higher than that of the control group (P < 0.05), and the LVET of the experimental group was significantly higher than that of the control group (P < 0.05). The STR of the experimental group was shorter than that of the control group (P < 0.05), the PEP of the experimental group was shorter than that of the control group (P < 0.05), and the PEP of the experimental group at 24 h was shorter than that of the control group (P 0.05). The CK of the experimental group was significantly lower than that of the control group at 6 h (P < 0.05). There was no significant difference in CK-MB and hs-TnI between the experimental group and the control group at 12 and 72 hours (P < 0.05), but the BNP in the experimental group was lower than that in the control group at 24 h and 48 h and 72 h (P < 0.05), there was statistical difference between the experimental group and the control group (P < 0.05). The LAC of the experimental group was significantly lower than that of the control group (P < 0.05), and the CVP of the experimental group was lower than that of the control group (P < 0.05) at 24 h and 72 h, respectively. The GCS of the experimental group was significantly higher than that of the control group at 24 h and 72 h (P < 0.05). Conclusion: Non-invasive dynamic monitoring of hemodynamics by thoracic impedance method can effectively guide the application of vasoactive drugs during cardiopulmonary resuscitation after cardiac arrest, increase the blood supply to the heart and accelerate the recovery of myocardial cells damaged by ischemia and hypoxia. Increase myocardial ejection function, increase cardiac output, reduce heart failure, promote the recovery of cardiac function; Increase cerebral blood flow, reduce cerebral ischemia time, reduce ischemia-reperfusion time, reduce cerebral ischemia reperfusion injury, protect brain nerve cells, promote the recovery of brain function. Reducing blood lactic acid level and tissue hypoxia as early as possible is beneficial to the balance of oxygen metabolism and stability of internal environment. It is of great significance for the protection of organ function after cardiopulmonary resuscitation (CPR). To promote the recovery of prognosis.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R459.7
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