无创血流动力学监测在急性中重度农药中毒病情评估中的作用

The role of noninvasive hemodynamic monitoring in the evaluation of acute and severe pesticide poisoning

目的探讨无创血流动力学监测系统(NICaS)监测急性中重度农药中毒患者的血流动力学方法,分析NICaS在急性中重度农药中毒患者血流动力学的临床指导价值。方法于2019年8月,选取2017年1月至2019年8月收住哈励逊国际和平医院的急性重度有机磷农药中毒(AOPP)患者和中-重型急性百草枯农药中毒(APP)患者,共200例作为研究对象,将其随机分为NICaS组68例、经肺热稀释法组(Picco组)67例、经验治疗组(经验组)65例。分析3组患者急性生理学和慢性健康评分(APACHEⅡ)、心率、血流动力学指标、生存率和并发症的关系。结果NICaS组、Picco组和经验组患者年龄、性别构成比、体重指数、心率、收缩压、无治疗期及入院APACHEⅡ评分差异均无统计学意义(P>0.05);与经验组比较,NICaS组、Picco组患者AOPP及APP住院病死率均较低,差异均有统计学意义(P<0.05)。心排出量(CO)在2.8~6.7 L·min^(-1)的相关性明显(r=0.738,r^(2)=0.545,P<0.01),外周血管阻力指数(SVRI)在410~1950 d·s·cm^(-5)·m^(2)的相关性明显(r=0.792,r^(2)=0.627,P<0.01)。Bland-Altmen分析显示,Picco和NICaS法所测得CO和SVRI值分别具有97.01%、95.52%的一致性。与经验组比较,NICaS组和Picco组患者平均每日输液量、每日输注胶体液量均较低,差异均有统计学意义(P<0.05),各组间获得CO时间差异均有统计学意义(P<0.05)。结论NICaS可在急性中重度农药中毒患者抢救中有效监测患者血流动力学指标。

Objective To explore the method of noninvasive hemodynamic monitoring system(NICaS)in monitoring the hemodynamics of patients with acute pesticide poisoning,and to analyze the clinical guiding value of NICaS in hemodynamics of patients with severe pesticide poisoning.Methods In August 2019,200 patients with severe acute organophosphorus pesticide poisoning(AOPP)or moderate severe acute paraquat pesticide poisoning(APP)admitted to Harrison international peace hospital from January 2017 to August 2019 were randomly divided into NICaS group(n=68),transpulmonary thermodilution method(n=67)and empirical treatment group(n=65).The relationship between acute physiology and chronic health score(APACHEⅡ),heart rate,hemodynamic indexes,survival rate and complications were analyzed.Results There were no significant differences in age,sex ratio,body mass index,heart rate,systolic blood pressure,no treatment period and admission APACHE II score between NICaS group,Picco group and experience group(P>0.05);Compared with the experience group,the mortality of AOPP and app in NICaS group and Picco group were lower,and the differences were statistically significant(P<0.05).The cardiac output(CO)had a significant correlation in the interval of 2.8-6.7 L·min^(-1)(r=0.738,r^(2)=0.545,P<0.01),and peripheral vascular resistance index(SVRI)had a significant correlation in the interval of 410-1950 d·s·cm^(-5)·m^(2)(r=0.792,r^(2)=0.627,P<0.01).Bland Altman analysis showed that CO and SVRI measured by Picco and NICaS had 97.01%and 95.52%consistency,respectively.Compared with the experience group,the average daily infusion volume and daily colloid infusion volume of NICaS group and Picco group were lower,the differences were statistically significant(P<0.05).Conclusion NICaS can effectively monitor the hemodynamic indexes of patients with acute pesticide poisoning.