胸腔阻抗无创血流动力学监测在非心脏手术老年患者全麻术后的临床应用

Clinical application of non-invasive hemodynamic monitoring by thoracic electrical bioimpedance in elderly non-cardiac surgery patients after general anaesthesia

目的评价胸腔阻抗（TEB）无创血流动力学监测在非心脏手术老年患者全麻术后的应用价值。方法选取收治于ICU的非心脏手术全麻术后老年患者56例，按照随机数字表法分为对照组和TEB组，每组28例，所有患者均给予常规监护并监测中心静脉压，TEB组在上述基础上行TEB无创血流动力学监测，根据监测结果给予利尿药、正性肌力药、血管扩张剂或补液治疗；比较两组患者心率、平均动脉压、中心静脉压、尿量以及机械通气时间、住ICU时间。结果两组患者同一时间相应的心率、平均动脉压、中心静脉压、尿量比较差异均无统计学意义（P〉0．05）。机械通气时间TEB组患者为（19．5±15．9）h，较对照组的（25．54±16．5）h缩短，但差异无统计学意义（P=0．173）；住ICU时间TEB组患者为（2．8±1．0）d，较对照组的（3．6±1．6）d缩短，且差异有统计学意义（P=0．032）。结论TEB无创血流动力学监测对非心脏手术老年患者全麻术后的治疗具有指导作用，有利于患者的术后恢复。

Objective To evaluate the application value of non-invasive hemodynamic monitoring by thoracic electrical bioimpedance （TEB） in elderly non-cardiac surgery patients after general anaesthesia. Methods Fifty-six elderly non-cardiac surgery patients after general anaesthesia were divided into control group and TEB group with 28 patients in each group by random digits table. All patients received standardized care including central venous pressure （VAP）. Besides these monitoring, hemodynamic monitoring by TEB was used to evaluate the hemodynamic state of patients in TEB group. Diuretics,inotropic agents, vasoactive drugs or intravenous fluid therapy were used according to monitoring guidance. The heart rate （HR）, mean arterial pressure （MAP）, VAP, urine output （UO） were recorded in different time. The length of mechanical ventilation and ICU stay were also recorded. The difference in HR, MAP, VAP, UO, the length of mechanical ventilation and ICU stay between two groups were analyzed. Results The differences between two groups had no significance in HR, MAP, VAP, UO at the same time（P 〉 0.05 ）. The length of mechanical ventilation of TEB group [ （ 19.5±15.9 ） h ] was shorter as compared to that of control group [ （25.5±16.5 ） h ], but the difference was not significant （P =0.173）. The ICU stay of TEB group [（2.8 ± 1.0） d ] was shorter as compared to that of control group [ （3.6 ± 1.6 ） d ] and the difference was significant （P = 0.032 ）. Conclusion Non-invasive hemodynamic monitoring by TEB can monitor the changes of hemodynamics and direct treatment in elderly non-cardiac surgery patients after general anaesthesia.