快速拔管超声评分与心脏术后患者多器官信息临床指标的相关性研究

The Correlation of Fast-track Extubation Ultrasound Score and Clinical Multi-organ Information Indicators of Postoperative of Cardiac Surgery

目的探讨快速拔管超声评分(fast-track extubation ultrasound score, FTEUS)用于反映心脏术后患者多器官信息临床指标的价值。方法前瞻性纳入华西医院2019年2~9月,心脏大血管术后,准备拔管脱离呼吸机的患者。根据心脏术后患者特点,制定快速拔管超声评分方案(fast-track extubation ultrasound score protocol, FTE-USP),即在常规快速脱机标准的基础上,使用FTEUS对患者进行流程化、个体化的评估。由两位观察者分别使用FTE-USP进行患者超声影像评价,并用Kendall一致性系数判断观察者间一致性。评估FTEUS与各临床指标的相关性。结果共207例患者纳入研究,其中男性89例,女性118例,年龄为(54.63±11.80)岁,FTEUS均在床旁完成,完成时间为(8.23±2.08) min,观察者间Kendall一致性系数0.941。随FTEUS总分增加,临床不良事件发生率随之增加(特别是心律失常发生率增加),肝、肾、心、肺等器官功能指标有明显变化,其中血清肌酐水平、血清胱抑素C水平、血清N端脑钠肽前体水平、术后监护室时间、拔管后无创机械通气时间、心律失常发生率与FTEUS呈正相关(P<0.05)。FTEUS达到5分时,心律失常(14/24,58.3%)、心肺复苏(2/24,8.3%)、脱机失败(2/24,8.3%)发生率均增加。结论 FTE-USP整合了多器官信息,可于心脏术后患者床旁快速完成,并警示不良事件,有应用于协助临床决策的潜力。

Objective To evaluate the correlation of Fast-track extubation ultrasound score(FTEUS)and clinical multi-organ information indicators in post-cardiac surgery patients.Methods prospectively recruit postcardiac surgery patients who were about to extubating from Febuary 2019 to September 2019.A fast-track extubation ultrasound score protocol(FTE-USP)was developed on the basis of the conventional fast-track extubation standard precisely and individualized.Cardiac,pulmonary and inferior vena cava ultrasound examinations were performed by specially trained observers,video data were saved,FTE-USP was used for scoring,Kendall consistency coefficient was used to meature the interobserver consistency.The correlation between the FTEUS and the patients’ clinical indicators was evaluated.Results A total of 207 patients were recruited in the study,including 89 males and 118 females,aged(54.63±11.80)years.The FTEUS was performed at bedside with a mean time of(8.23±2.08)min,Kendall consistency coefficient is 0.941.With the increase of the total score of FTEUS,the incidence of clinical adverse events increased(especially the arrhythmia),and there were significant changes in liver,kidney,heart,lung and other organ function indicators,among which serum creatinine level,serum cystatin C level,serum NT-pro-brain natriuretic peptide,length of stay in intensive care unit,non-invasive mechanical ventilation time after extubation,and incidence of arrhythmia were positively correlated with FTEUS(P<0.05).With FTEUS increased to 5 points,the incidence of arrhythmia(14/24,58.3%),cardiopulmonary resuscitation(2/24,8.3%)and weaning failure(2/24,8.3%)increased.Conclusion FTE-USP integrates multiorgan informations,can be performed quickly at the bedside and alerts adverse events.It has the potential to be applied to assist clinical decision-making in post-cardiac surgery patients before extubation.