亚低温治疗对心肺复苏术后患者血流动力学的影响研究

摘要

目的：应用脉波轮廓温度稀释连续心排量监测技术（PICCO）观察亚低温治疗对心肺复苏后自主循环恢复患者血流动力学及氧代谢的影响。方法按照随机分配原则对36例心肺复苏术后自主循环恢复患者进行分组，根据亚低温治疗时间分为12小时组和24小时组，在心肺复苏后自主循环恢复即刻，亚低温治疗后24、48 h分别应用PICCO记录心率（HR）、平均动脉压、中心静脉压、全心舒张末容积、外周血管阻力指数（SVRI）、心排量指数（CI）及左心室收缩指数（LVSI），并在各时间点取静脉血测血浆乳酸水平。结果（1）在亚低温治疗后24 h时，与12小时组比较，24小时组患者PICCO参数外周血管阻力指数增加[（1683±467）dyn·s·cm-5·m2 vs.（1732±490）dyn·s·cm-5·m2]，HR下降[（71±13）次/分vs.（60±14）次/分]及CI降低[（2.6±0.6）L·min-1·m-2 vs.（2.1±0.6）L·min-1·m-2]，差异均有统计学意义（P＜0.05）。全心舒张末容积及LVSI比较，差异无统计学意义（P＞0.05）；（2）在亚低温治疗后48 h时，两组间PICCO参数SVRI、HR及CI比较，差异无统计学意义（P＞0.05）；（3）在亚低温治疗后24、48 h时，两组乳酸水平、混合静脉血氧饱和度比较，差异无统计学意义（P＞0.05）。结论（1）亚低温对心肺复苏后自主循环恢复患者血流动力学的影响主要表现为心排量和HR的下降，以及外周血管阻力的增加，这种影响为非持续性，随着亚低温状态的消除而消失；（2）亚低温持续时间对心肺复苏后自主循环恢复患者氧代谢无影响。%Objective To apply the pulse index continuous cardiac output (PICCO) monitoring technique to observe the impact of sub-hypothermia therapy on patient′s hemodynamics after cardiopulmonary resuscitation. Methods Thirty-six patients with spontaneous circulation recovery after cardiopulmonary resuscitation were divided into the 12 h group and 24 h group accord-ing to the random allocation principle and the sub-hypothermia therapy time. PICCO was used to record the heart rate (HR),mean arterial pressure,central venous pressure (CVP),end-diastolic volume,systemic vascular resistance index (SVRI),cardiac output index(CI),left ventricular systolic index(LVSI) at instantly autonomous circulation recovery after cardiopulmonary resuscitation, 24,48 h after sub-hypothermia therapy. Moreover at the same time points the venous blood was collected for detecting plasma lac-tic acid level. Results (1) Compared with the 12 h group,SVRI at 24 h after sub-hypothermia therapy in the 24 h group was in-creased[(1 683±467) dyn·s·cm-5·m2 vs.(1 732±490) dyn·s·cm-5·m2,P<0.05],HR was decreased[(71±13)beats/min vs.(60±14) beats/min,P<0.05] and CI was reduced[(2.6±0.6)L·min-1·m-2 vs.(2.1±0.6)L·min-1·m-2],the differences were statistically signifi-cant(P<0.05),but the whole end-diastolic volume and LVSI had no statistical difference between the two groups (P>0.05);(2)At 48 h after sub-hypothermia therapy,SVRI,HR and CI had no statistical difference between the two groups(P>0.05);(3)At the time points of 24,48 h after sub-hypothermia therapy,the lactic acid level and SvO2 had no statistical difference between the two groups (P>0.05). Conclusion (1)The impact of sub-hypothermia on hemodynamics in the patients with spontaneous circulation recov-ery after cardiopulmonary resuscitation is mainly manifested by the decrease of cardiac output and HR and increases of SVRI,but this impact is non-persistent and disappears with the sub-hypothermia status elimination;(2)The sub-hypothermia duration has no impact on the oxygen metabolism in the patients with spontaneous circulation recovery after cardiopulmonary resuscitation.