胸阻抗法无创血流动力学监测指导心肺复苏后血管活性药物的应用

Non- invasive hemodynamic monitoring by thoracic impedance method guides the application of vasoactive drugs in patients after cardiopulmonary resuscitation

目的评估胸阻抗法无创血流动力学的监测在心肺复苏后血管活性药物应用中的指导作用。方法选取心搏骤停后自主循环恢复的患者13例,随机分为实验组(n=7)及对照组(n=6)。实验组根据胸阻抗法测定的CO值来指导血管活性药物的应用,对照组根据外周血压的变化按常规方法调整血管活性药物的应用。入院后(院外心搏骤停)或自主循环恢复后(院内心搏骤停)1、6、12、24、48和72 h监测心率、上肢动脉血压、指尖血氧饱和度和血气分析;胸阻抗法检测CO和CI;检测0 h和6 h动脉血乳酸并计算6 h乳酸清除率;72 h后进行GLS评分;观察28天存活率。结果两组患者在各时间点的心率、血压、指尖血氧饱和度和动脉血氧分压的差异无显著性意义;实验组在6、12、24、48及72 h的CO和CI均高于对照组(均P<0.05);实验组6 h乳酸清除率和72 h的GLS均高于对照组(均P<0.05);两组患者的28天存活率差异无显著性意义。结论胸阻抗法无创血流动力学的监测可以用于指导心肺复苏中血管活性药物的应用。

Objective To assess the effect of non -invasive hemodynamic monitoring by thoracic impedance method on guiding the application of vasoactive drugs in patients after cardiopulmonary resuscitation. Methods Thirteen patients after return of spontaneous circulation （ROSC） were randomly divided into experimental （ n = 7） and control （ n = 6） groups. In the experimental group, the application of vasoactive drugs was adjusted according to the cardiac output （CO） values obtained using thoracic impedance method. In the control group, the application of vasoactive drugs was adjusted according to changes of peripheral arterial blood pressure. At 1, 6, 12, 24, 48 or 72 h after admission to hospital （ out - of- hospital cardiac arrest） or after ROSC （in -hospital cardiac arrest）, heart rate, upper limb arterial pressure, fingertip pulse blood oxygen saturation and arterial blood gas were measured, and CO and cardiac index （CI） were measured using thoracic impedance method. Arterial lactate levels at 0 h and 6 h were measured and 6 - hour lactate clearance was calculated. At 72 h Glasgow Coma Score （GLS） was evaluated. Twenty eight - day survival rate was observed. Results Heart rate, upper limb arterial pressure, fingertip pulse blood oxygen saturation and arterial partial pressure of oxygen did not differ significantly between the two groups at each time point. The values of CO and CI at 6, 12, 24, 48 or 72 h were higher in the experimental group than those in the control group （ all P 〈 0.05 ）. The 6 - hour lactate clearance and 72 h GLS were higher in the experimental group than those in the control group （ all P 〈 0.05 ）. There was no significant difference in 28 - day survival rate between the two groups. Conclusion Non - invasive hemodynamic monitoring by thoracic impedance method can guide the application of vasoactive drugs in patients after cardiopulmonary resuscitation.