床旁超声心动图监测重症患者血容量及心脏功能的临床研究

Clinical study of blood volume and cardiac function in critical patients by bedside echocardiography

目的探讨床旁超声心动图监测重症患者血容量及心脏功能的临床价值。方法选择我院重症医学科感染性休克患者52例,脉搏指示连续心输出量(PiCCO)导管法检测全心舒张末期容积指数(GEDI)、每搏量指数(SVI)、心排指数(CI)、全心射血分数(GEF)评估血容量及心功能;同时行床旁超声心动图监测左室舒张末期容积(LVEDV)、每搏量(SV)、心输出量(CO)、下腔静脉管径(IVC)、左室射血分数(LVEF);在PiCCO指导下经扩容治疗及应用血管活性药物治疗第2天,再次行床旁超声监测评估血容量及心功能,比较床旁超声心动图监测重症患者血容量及心脏功能与PiCCO导管方法测量的准确性。结果扩容治疗后床旁超声心动图所测LVEDV、SV、IVC、CO及LVEF均增高,与扩容治疗前比较差异均有统计学意义(均P<0.05);床旁超声心动图监测指标LVEDV、SV、CO、LVEF分别与PiCCO导管监测指标GEDI、SVI、CI及GEF呈正相关(r=0.614、0.703、0.536、0.573、0.527、0.514、0.498、0.487,均P<0.01)。结论床旁超声心动图监测重症患者血容量及心脏功能结果可信,弥补了PiCCO导管法诸多不足。

Objective To assess the accuracy of bedside echocardiography for monitoring blood volume and cardiac function in critical patients.Methods Fifty-two patients with sepsis shock were enrolled.The left ventricular end-diastolic volume（LVEDV）,stroke volume（SV）,cardiac output（CO）,inferior vena cava diameter（IVC）and left ventricular ejection fraction（LVEF）were measured by bedside echocardiography,and global end- diastolic volume index（GEDI）,stroke volume index（SVI）,cardiac index（CI）,global ejection fraction（GEF）were measured by the PiCCO catheter. These patients were treated by increasing the blood volume and vasoactive drugs after that,the blood volume and cardiac function were monitored by bedside echocardiography again,and the accuracy of bedside echocardiography and PiCCO were compared.Results LVEDV,SV,IVC,CO and LVEF were higher compared with before treatment,and the differences were statistically significant（all P〈0. 05）. Data of bedside echocardiography and PiCCO were positive correlation significantly（r=0.614,0.703,0.536,0.573,0.527,0.514,0.498,0.487,all P〈0.01）.Conclusion Bedside echocardiography possess superiority compared with PiCCO catheter, and its result is believable and can be duplicated.