动态动脉弹性对低血容量性休克患者扩容后血压变化的影响

摘要

目的：探讨动态动脉弹性对低血容量性休克患者扩容后血压变化的影响。方法选择休克患者28例，根据快速扩容后患者平均动脉压（ MAP）升高程度，分为研究组（ MAP升高≥15﹪）和对照组（ MAP升高﹤15﹪）。在快速扩容前后检测两组血流动力学指标，包括脉压变异度（ PPV）、每搏变异度（ SVV）、平均动脉压（ MAP）、脉压（ PP）、全心舒张末容积指数（ GEDVI）、心输出量（ CO）、每搏量指数（ SVI）、全身血管阻力指数（ SVRI）等，计算动脉弹性（ Ea）、动态动脉弹性（ Eadyn）并比较。结果两组的MAP、PP、SVI、CO、PPV、SVV、SVRI在扩容前后均有显著差异。扩容后，研究组MAP显著高于对照组，而Eadyn在扩容前于两组间就有统计学差异。逐步回归分析发现Eadyn是影响快速扩容前后MAP变化的重要因素。结论 Eadyn可较好地反映休克患者快速扩容后的血压反应性，值得临床参考应用。%Objective To investigate the influence of dynamic arterial elasticity on the changes of blood pressure in patients with hypov_olemic shock after expansion. Methods A total of 28 patients with shock were collected. According to the degree of mean arterial pressure ( MAP)increased after rapid expansion,the patients were divided into study group( MAP increased≥15﹪)and control group( MAP increased﹤15﹪). Hemodynamic parameters were detected and recorded before and after rapid expansion,including pulse pressure variability( PPV), stroke volume variability( SVV),MAP,pulse pressure( PP),global end-diastolic volume index( GEDVI),cardiac output( CO),stroke vol_ume index( SVI),systemic vascular resistance index( SVRI),etc. Arterial elasticity( Ea)and dynamic arterial elastance( Eadyn)were calcu_lated and compared. Results MAP,PP,SVI,CO,PPV,SVV and SVRI were significantly different before and after the expansion in both groups. After the expansion,MAP in the study group was significantly higher,while there was significant difference in Eadyn before expansion be_tween the two groups. Stepwise regression analysis found Eadyn was an important factor affecting MAP changing before and after the rapid expan_sion. Conclusion Eadyn can better reflect blood pressure after the rapid expansion in shock patients.