超声心动图指导心脏术后患者容量管理的研究

Research of Echocardiographic Guidance in Capacity Management in Cardiac Surgery Patients

目的:研究超声心动图指导心脏术后患者容量管理的临床效果。方法:选取2016年7月-2016年12月我院心外ICU收治的79例成人心脏病术后循环不稳的患者。将入选患者随机分为超声心动图指导容量管理组(A组)、常规容量管理组(B组)及脉波指示剂连续心排血量法(Pi CCO)指导容量管理组(C组)。记录治疗前(T0)、治疗开始后第4小时(T1)、第12小时(T2)、第24小时(T3)、第48小时(T4)3组患者的循环灌注指标;T0、T4时的心功能指标及预后。结果:与B组相比,A组T1、T2时的循环灌注指标明显改善(P<0.05),T4时动脉血BNP浓度下降(P<0.05);并发症发生率、机械通气时间及ICU住院时间均下降(P<0.05),但28天死亡率无统计学差异;与C组相比,A组所有指标无统计学差异。结论:超声心动图用于指导心脏术后患者容量管理,可良好维持机体血流动力学稳定及脏器灌注,改善心肺功能,降低并发症发生率,与Pi CCO指导容量管理方案临床效果无差异。

Objective：To assess the clinical effect of echocardiographic guidance in capacity management in cardiac surgery patients. Methods：From July 2016 to December 2016,a total of 79 adult heart surgery patients in ICU with unstable circulation were divided into three groups randomly. They were echocardiograph management group（group A）,routine treatment group（group B）and pulse indicator continuous cardiac output（Pi CCO）management group（group C）. The parameters of circulation perfusion were recorded before treatment（T0）,at 6 h（T1）,12 h（T2）,24 h（T3）,48 h（T4）after treatment. The Cardiac function indexes were recorded at T0,T4 and the prognosis as well.Results：Compared with group B,there was statistical difference（P〈0.05）in the parameters of circulation perfusion at T1 and T2 and BNP level at T4 and complication rates,mechanical ventilation time and ICU treatment time in group A.But there was no statistical difference in 28-day mortality between group A and B. Compared with group C,no statistical difference was found in all indicators of group A. Conclusion：In capacity management in cardiac surgery patients,echocardiographic guidance is beneficial for hemodynamic stability and viscera perfusion,and can improve cardiopulmonary function and reduce complications. The clinical effects were no difference with guidance of Pi CCO.