超声监测容量反应性在静脉-动脉体外膜肺氧合撤机中的价值

Value of ultrasound monitoring the volume responsiveness in the weaning of venous-arterial extracorporeal membrane oxygenation

目的:探讨超声监测容量反应性在静脉-动脉体外膜肺氧合(VA-ECMO)撤机中的价值。方法:收集接受VA-ECMO支持治疗的左心功能衰竭患者27例,均行撤机试验,将撤机试验成功者纳入A组(20例),将撤机试验失败者纳入B组(7例)。在撤机试验前,应用超声检测患者的主动脉速度-时间积分呼吸变异率(ΔVTI)、下腔静脉呼吸变异指数(ΔRVI)、左室射血分数(LVEF),同时监测中心静脉压(CVP)、心率,并对2组数据进行比较。结果:A组撤机试验前ΔVTI>B组(P<0.05);2组撤机试验前ΔRVI、LVEF、CVP、心率比较差异均无统计学意义(均P>0.05)。结论:超声监测患者容量反应性在VA-ECMO撤机过程中有重要价值。

Objective:To explore the value of ultrasound monitoring the volume responsiveness in the weaning of venous-arterial extracorporeal membrane oxygenation(VA-ECMO).Methods:27 patients ongoing VA-ECMO for different reasons were selected.According to the VA-ECMO weaning test,all patients were divided into successfully weaning group(Group A)and unsuccessfully weaning group(Group B).Before the weaning test,the patients were examined with ultrasound for the aortic respiratory variability of velocity time integral(ΔVTI),respiratory variability index(ΔRVI)of inferior vena cava and left ventricular ejection fraction(LVEF),the central venous pressure(CVP)and heart rate were monitored,and the data of the two groups were compared.Results:Of the 27 patients,20 cases were in Group A and 7 in Group B.TheΔVTI of Group A was greater than that of Group B before the weaning test,and the difference between the two groups was statistically significant(P<0.05).There were no significant differences inΔRVI,LVEF,CVP and heart rate between the two groups(all P>0.05).Conclusion:Ultrasound monitoring of the volume responsiveness is of great value in the VA-ECMO weaning process and is worthy of clinical application.