无创血流动力学监测在危重患者液体管理中的应用

Application of noninvasive hemodynamic monitoring in the liquid management for critical patients

目的观察无创血流动力学监测在危重患者液体管理中的临床应用价值。方法选取2016年6月至2017年6月重庆市荣昌区人民医院重症医学科收治的急危重症患者62例作为研究对象,分为观察组和对照组,每组31例。对照组给予常规液体管理,观察组采用无创血流动力学合并多种监测手段指导液体管理,比较两组患者液体管理效果及转归。结果两组患者治疗3 d后心率、平均动脉压、中心静脉压、氧合指数、血乳酸、急性生理和慢性健康估测评分均较治疗前明显改善,脑钠肽、血清肌酐均较治疗前明显降低,差异均有统计学意义(P<0.05),且观察组患者平均动脉压、氧合指数均明显高于对照组,心率、中心静脉压、血乳酸、急性生理和慢性健康估测评分、脑钠肽、血清肌酐均明显低于对照组,差异均有统计学意义(P<0.05)。结论在无创血流动力学监测指导下应用液体管理治疗危重患者效果理想,较常规液体管理更有利于保护患者重要脏器功能,提高临床液体管理质量,建议临床推广应用。

Objective To observe the clinical application of noninvasive hemodynamic monitoring in the liquid management for critical patients. Methods A total of 62 critical patients in ICU of Rongchang District People＇s Hospital of Chongqing from June 2016 to June 2017 were selected and divided into the observation group and the control group randomly,31 cases in each group. The patients in the control group were with conventional liquid management,while the patients in the observation group were with noninvasive hemodynamic monitoring combined with various monitoring measures to guide liquid management. The effect and prognosis of liquid management of the patients in the two groups were compared. Results Compared with before treatment,patients in both groups showed a significant improvement in the heart rate（HR）,mean arterial pressure（MAP）,central venous pressure（CVP）,oxygenation index（OI）,blood lactic acid（BLA）,acute physiology and chronic health score（APACHEⅡ）after 3 d treatment,while the levels of brain natriuretic peptide（BNP）and serum creatinine（Scr）reduced obviously,and the difference had statistical significance（P〈0.05）. The MAP,OI in the observation group were prominently higher than those in the control group,while the HR,CVP,BLA,APACHEⅡ ,BNP,Scr were remarkably lower than those in the control group,with statistically significant difference（P〈0.05）. Conclusion Under the guidance of noninvasive hemodynamic monitoring,liquid management can achieve ideal results in treating critical patients,moreover,it is more beneficial to protect important organ function of the patients and improve clinical liquid management quality comparing with conventional liquid management. Therefore,noninvasive hemodynamic monitoring is worthy of clinical application and opularization.