下腔静脉扩张指数对AECOPD机械通气患者血流动力学评估的意义

摘要

目的 探讨下腔静脉扩张指数(dIVC)对急性加重期慢性阻塞性肺病(AECOPD)机械通气患者血流动力学评估的意义.方法 选取2015年1月至2017年1月在我院接受治疗AECOPD患者68例,采用随机法把患者分为对照组和研究组,每组患者各34例.对照组患者给予中心静脉压(CVP)对AECOPD机械通气患者进行输液指导,研究组患者给予重症超声测量dIVC评估对AECOPD机械通气患者对进行输液指导.观察并比较两组患者治疗前后的心率、氧合指数(PaO2/FIO2)和脑利钠肽前体(NT-proBNP)水平,比较两组患者撤机时间、住ICU时间和不良事件发生率情况.结果 两组患者治疗前心率、PaO2/FIO2和NT-peoB-NP水平比较,差异无统计学意义(P＞0.05);治疗后两组患者心率和NT-proBNP水平均较治疗前下降,PaO2/FIO2较治疗前上升(P＜0.05);研究组心率、NT-proBNP水平下降幅度及PaO2/FIO2上升幅度均较对照组大(P＜0.05).研究组患者撤机时间(9.14±1.79)d和住ICU时间(8.67±2.02)d,均显著短于对照组患者(P＜0.05).研究组患者重新插管率11.8％、病死率0.0％及呼吸机相关性肺炎(VAP)率2.9％均低于对照组患者(P＜0.05).结论 评估下腔静脉扩张指数来指导AECOPD机械通气患者输液,可以降低患者心率及NT-proBNP水平,改善PaO2/FIO2,缩短住ICU时间、带呼吸机时间,减少不良事件发生率,值得临床推广应用.%Objective To investigate the significance of dilated index of inferior vena cava on hemodynamic assessment of AECOPD patients with mechanical ventilation.Methods 68 patients with AECOPD who were treated in our hospital from January 2015 to January 2017 were randomly divided into the control group and the study group,and each group had 34 patients.The control group was given central venous pressure (CVP),and the study group was given severe ultrasound measurement dIVC evaluation.Their heart rate,oxygenation index (PaO2/FIO2) and brain natriuretic peptide (NT-proBNP) levels were observed and compared between the two groups before and after treatment,and ICU stay and adverse events were also compared.Results There was no significant difference in heart rate,PaO2/FIO2 and NT-proBNP between the two groups (P ＞ 0.05).Their heart rate and the level of NT-proBNP decreased,and PaO2/FIO2 increased after the treatment (P ＜ 0.05).Their heart rate and NT-proBNP decreased and PaO2/FIO2 increased more obviously in the study group than in the control group (P ＜ 0.05).The ventilation withdraw time was 9.14 ± 1.79 d and the duration of ICU stay was 8.67 ± 2.02 d in the study group,which were significantly shorter than those in the control group (P ＜ 0.05).In the study group,the rate of re-intubation was 11.8％,the mortality was 0％,and the rate of ventilator-associated pneumonia (VAP) was lower in the study group than in the control group (2.9％) (P ＜0.05).Conclusion The evaluation index to guide the expansion of the inferior vena cava infusion of AECOPD patients with mechanical ventilation can reduce the heart rate and the level of NT-proBNP,improve PaO2/FIO2,shorten ICU stay and mechanical ventilation time,and reduce the incidence of adverse events.