亚低温在心源性休克中的运用

The application of hypothermia therapy on cardiogenic shock

目的探讨亚低温对于心源性休克患者血流动力学及生存率影响。方法选择心源性休克病人90例,分成亚低温组和对照组。亚低温组给予亚低温治疗:用冰毯或经血液净化管路输入冷置换液把目标温度设置为33℃左右。同时经股动脉置入脉搏指示持续心排监测(Pulse indicator Continuous Cardiac Output,PICCO)导管,接仪器监测血流动力学参数。分别记录患者降温前血压(0h)、降温后8、16、24h心指数(cardiac output index,CI),心率(heart rate,HR),血管外周阻力等变化(system vascular resistance index,SVRI);观察病人2个月内存活率。对照组给予目前常规治疗,其他治疗同亚低温组。结果两组均通过调整血管活性药物控制血压,血压无明显差异。病人心率在亚低温组稍显降低,但统计学无差异。心脏指数亚低温组增高,P<0.05,有统计学差异。两温组外周阻力没有明显差异。亚低温组应用去甲肾上腺素量较低,P<0.05有统计学差异。结论亚低温对于心源性休克患者能增加心输出量,减少血管活性药物的使用。

Objective To evaluate the effect of hypothermia therapy on cardiac hemodynamics and survival rate of patients with cardiogenic shock. Methods 90 patients with cardiogenic shock were divided into hypothermia group and the control group. Hypothermia group was treated with hypothermia therapy：Set the temperature to 33℃ with ice-cold blanket or injecting displacement fluid through blood purification line,place PICCO via femoral artery catheter,connect the monitoring instrument to observe hemodynamic parameters ,record the cardiac output index, heart rate, system vascular resistance index（SVRI） before cooling, 8,16, 24 hours after cooling blood pressure respectively, observe the patient survival rate after two month. Control group were given conventional treatments,other are equivalent to hypothermia group. Results Both of the two groups adjusting blood pressure by vasoactive medications ,the blood pressures have no obviously difference. The patients＂ heart rates in the hypothermia group are slightly lower, but there is no difference in statistics. Cardiac output index of hypothermia group increased a little ,P〈0.05 ,there is a statistically significant difference. There are no significant differences between two groups in SVRI. Hypothermia group applied a lower amount of norepinephrine,P〈0.05, also a statistically significant difference. Conclusion Hypothermia therapy on cardiogenic shock can increase cardiac output and reduce vasoactive agents＇ use.