阻抗心动描记法在感染性休克患者早期目标导向治疗中的应用

摘要

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。%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.