经食道多普勒超声监测系统评估危重烧伤早期的血流动力学变化

Study on hemodynamic changes in severely burned patients with transesophageal Doppler ultrasonography at the burn shock stage

目的应用经食道超声多普勒技术对危重烧伤休克期患者进行血流动力学动态观察和临床评估。方法对16例危重烧伤（烧伤面积〉／30％TBSA）患者应用经食道多普勒超声监测系统监测血流动力学指标包括主动脉血流量（ABF）、每搏输出量（SVa）、左心室峰值流速（PV）、左心室血流最大流速（ACC）、左心室射血时间（LVET）、外周血管阻力（TSvR）的变化。结果危重烧伤后ABF、SVa、PV、ACC明显下降，伤后12h达最低值，以后逐渐回升。LVET在伤后早期低于正常，以后逐渐升高，伤后1211后保持相对乎稳。TSVR在伤后早期高于正常，以后逐渐下降，伤后24h接近正常水平。结论危重烧伤休克期和围手术期应用经食道多普勒超声监测系统进行无创或微创血流动力学监测，能够为休克期和嗣手术期液体管理提供可靠而灵敏的客观依据。

Objective To evaluate the hemodynamic changes with transesophageal Doppler uhrasonography in severely burned patients at the burn shock stage. Methods Hemodynamic indices of 16 severely burned patients, including aortic blood flow （ABF）,stroke volume （SVa）, left ventrieular ejection time（LVET） , peak velocity（PV） , max acceleration（ ACC ） , total systemic vascular resistance （TSVR） were collected immediately after hospitalization and at 8,12,24,36,48 h after burn injury, and were determined by transesophageal Doppler uhrasonography. Mean artery pressure （MAP） , fluid intake and urinary volume were recorded. Results ABF, ACC, PV, SVa and LVET were also decreased continuously after burns until 12 h, but TSVR was obviously increased. For the patients with conventional therapy, the hemodynamic state of low cardiac output and high peripheral resistance during early period was converted to high cardiac output and low peripheral resistance 24 hours after injury. Conclusion Transesophageal Doppler ultrasonography can provide complete profile of hemodynamic data at the burn shock stage and in perioperative period in severely burned patieuts. The monitoring is safe and feasible, and helpful for resuscitation therapy and the maintenance of stable vital signs.