PiCCO监测在脊髓休克患者治疗中的应用

Role of pulse indicator continuous cardiac output in the treatment of patients with cervical spinal cord injury

目的:探讨脉搏指示连续心排血量(pulse indicator continuous cardiac output,PiCCO)监测在颈髓损伤患者治疗中的应用。方法:选取2009年至2013年入我院的颈髓损伤患者30例,采用PiCCO监测心排指数(CI)、外周血管阻力指数(SVRI)、全心舒张末期容量指数(GEDVI)、胸腔内血容量指数(ITBVI)以及血管外肺水指数(EVLWI)等指标,观察上述指标在治疗中的变化情况。结果:30例患者的心率(HR)、平均动脉压(MAP)、CI和SVRI均低于正常值,而颈4以上脊髓损伤患者的上述参数下降尤为明显(P<0.05)。应用多巴胺治疗后,上述指标明显好转(P<0.05或0.01),而GEDVI、ITBVI及EVLWI无明显变化(P>0.05)。结论:PiCCO监测能够及时发现急性脊髓损伤后血流动力学的异常(其严重程度与损伤平面高度有关),在神经源性休克的诊疗中发挥重要作用。

Objective：To explore the role of pulse indicator continuous cardiac output （PiCCO） in the treatment of patients with cervical spinal cord injury （CSCI）. Method：From 2009 to 2013,30 patients with CSCI in our hospi- tal were recruited. CI,SVRI,GEDVI, ITBVI, EVLWI were recorded before and after dopamine treatment by using PiCCO technique. Result： In these CSCI patients, heart rate （HR）, mean arterial pressure（MAP）, CI and SVRI were significantly decreased, especially in the patients with CSCI above C4 level （P〈0.05）. H R, MAP, CI and SVRI were markedly increased following dopamine treatment （P〈0.05 or 〈0.01）. There were no alterations in GEDVI, ITBV] and EVLWI parameters （P〉0.05）. Concluslun：PiCCO technique could timely detect the abnormal hemodynamics following CSCI, which was associated with the injury level of cervical vertebra. PiCCO played an important role in treatment with neurogenic shock secondary to CSCI.