高海拔地区感染性休克合并多器官功能障碍患者血流动力学变化的临床研究

CLINICAL STUDY OF HEMODYNAMIC CHANGE OF PATIENTS WITH SEPTIC SHOCK AND MOF AT HIGH ALTITUDE

目的：通过对感染性休克合并多器官功能障碍患者的血流动力学的临床监测，充分了解高海拔地区该组患者的血流动力学的变化特点；方法：采用Swan—Ganz导管及热稀释法心输出量测定技术对29例患者进行临床监测；结果：在给予容量复苏后，患者血流动力学变化呈明显高动力状态，其主要表现为心脏指数增加的体循环阻力指数下降，此变化在生存组和死亡组是一致的，但在抢救后的第3～4天，生存组心脏指数逐渐降至正常，体循环阻力指数逐渐回升，而死亡组则无任何变化；结论：体循环阻力指数的下降是感染性休克的关键环节，且与多器官功能障碍的发生与预后有密切的关系，而心脏指数的增加，则是针对缺氧和体循环阻力指数下降所出现的代偿反应。

Clinical hemodynamic data of the patients with septic and multi organ failure (MOF) were tested in order to learn change features of their hemodynamic at high altitude. Methods: 29 patients were monitored by Swan-Ganz cathter and thermodilution methods. Results: Hemodynandc changes of the patients remained at state of byperdynamic obviously after baying volume replacement. They mainly showed that CI was increased and SVRI was decreased. The changes were similar both in the surviving group (group S) and death group (group D). But CI was back to the normal and SVRI was increased gradually in group S after the third and fourth days of the rescure. There were no changes in group D. Conclusions:boresae of SVRI was a key of the septic shock and closely related to occourrance of the MOF and prognosis. Increase of the CI was compensation reaction on hypoxia and decrease of the SVRI.