USCOM在严重多发伤患者中心脏搏出量测量中的应用

Reliability of non-invasive ultrasonic cardiac output measurement in measurement of strtoke volume in patients with severe multiple trauma

目的探讨无创超声心输出量测定（uscOM）应用于严重多发伤患者的可靠性。方法急诊ICU的12例严重多发伤患者同时进行脉搏波形指示的连续心输出量（PiCCO）监测和USCOM监测，对比两种方法测得的每搏输出量（SV）这一血流动力学核心指标上的差异。结果12例患者中共有10例获得满意的血流超声多普勒影像，另2例慢性阻塞性肺疾病的患者因无法获得满意的超声结果而放弃。USCOM与PiCCO监测所得到的SV分别为（81．37±16．98）ml和（80．33±15．81）ml，USCOM测得的最小SV为40ml，最大SV为113ml，而PiCCO测得的最小SV为59ml，最大SV为106ml。相关分析显示，两组指标存在明显的相关性（Pearson相关系数0．855，P〈0．0001）。17次USCOM测得的SV高于PiCCO，这些患者的红细胞分钟距离（MD）为（25．53±4．43）m／min；13次USCOM测得的SV低于PiCCO测得的SV，其MD为（21．85±3．80）m／min，二者差别明显。USCOM得到数据时间为（3．26±0．91）min，明显低于PiCCO的时间（8．97±1．1）min，P〈0．05。结论无创超声心输出量测定准确、快速、安全，无创，适合在ICU严重多发伤患者中应用，但需注意在高动力循环患者存在高估SV的可能。

Objective To investigate the reliability of non-invasive ultrasonic cardiac output measurement （USCOM） in monitoring stroke volume （SV） in patients with severe multiple trauma. Methods Twelve patients with severe multiple trauma treated in emergency ICU underwent USCOM and pulse indicated continuous cardiac output （PiCCO） monitoring simuhaneoiusly. The paired values of SV measured by these 2 techniques were compared. Results Satisfying blood flow Doppler images were obtained from 10 out of the 12 patients. , and the other 2 patients, with chronic obstructive pulmonary disease, were excluded from the study due to the failure to obtain acceptable ultrasound signals. Thirty paired SV measurements were obtained totally. The SV value obtained by USCOM wase （81.37 ± 16.98） ml and that by PiCCO was （80.33 ± 15.81） ml. The SV values of 17 case-times of USCOM, with a minute distance （MD） of red cells of 25.53±4.43, were significantly higher than those by PiCCO, and the SV value of 13 case-times of USCOM, with a red cell MD of 21.85±3.80, was significantly lower than that by PiCCO. The time needed to get data was （3.26±0.91） rain for USCOM, significantly shorter than that for the PiCCO technique （P 〈0.0001）. Conclusion USCOM is accurate, fast, safe, non-luvasive , and suitable for use in ICU patients with severe multiple trauma. SV would be oveivalued in patients with hyperdynamtie circulatory state.