目标导向液体治疗对异位妊娠破裂并发失血性休克患者围手术期心肌酶谱的影响

Influence of Goal-Directed Fluid Therapy on Perioperative Myocardial Enzyme in Patients with Ectopic Pregnancy Rupture Complicated with Hemorrhagic Shock

目的:研究目标导向液体治疗运用于异位妊娠破裂并发失血性休克患者中的价值及对其围手术期心肌酶谱的影响。方法:选择本院2017年8月-2019年1月纳入的60例异位妊娠破裂并发失血性休克患者作为研究对象,遵照数字表法随机分为对照组和研究组,各30例。研究组采取目标导向液体治疗,对照组采取常规治疗。对比两组T0(手术前)、T_(1)(手术开始即刻)、T_(2)(手术30 min后)、T_(3)(手术1 h后)及T_(4)(手术结束时)不同时间点生命体征及心肌酶谱指标。结果:T_(0)、T_(4)时两组心率、平均动脉压及中心静脉压水平比较差异无统计学意义(P>0.05);T_(1)、T_(2)、T_(3)时,研究组心率低于对照组,平均动脉压及中心静脉压水平高于对照组(P<0.05);组内不同时间点心率、平均动脉压及中心静脉压水平比较差异有统计学意义(P<0.05)。T0时,两组肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)及肌钙蛋白T(cTnT)水平比较差异无统计学意义(P>0.05);T_(1)、T_(2)、T_(3)、T_(4)时,研究组CK、CK-MB及cTnT水平均优于对照组,差异有统计学意义(P<0.05)。结论:目标导向液体治疗运用于异位妊娠破裂并发失血性休克中效果显著,提升围术期的有效容量负荷,保护心肌,改善心肌酶谱相关指标水平,为预后提供保障。

Objective:To study the value of goal-directed fluid therapy in patients with ectopic pregnancy rupture complicated with hemorrhagic shock and its influence in myocardial enzyme.Method:A total of 60 patients with ectopic pregnancy rupture complicated with hemorrhagic shock included in our hospital from August 2017 to January 2019 were selected as the research subjects.According to the number table method,they were randomly divided into the control group and the study group,30 cases in each group.The study group adopted goal-directed fluid for treatment,the control group adopted conventional treatment.The vital signs and myocardial enzyme at T0(before surgery),T1(at the beginning of),T2(30 min after surgery),T3(1 h after surgery)and T4(at the end of surgery)of different time points were compared between the two groups.Result:There was no difference in heart rate,mean arterial pressure,and central venous pressure levels between the two groups at T0 and T4(P>0.05).At T1,T2,and T3,the heart rate of the study group was lower than that of the control group,and the mean arterial pressure and central venous pressure were higher than those of the control group(P<0.05).There were statistically significant differences in heart rate,mean arterial pressure and central venous pressure at different time points in the group(P<0.05).At T0,there were no statistically significant differences in the levels of creatine kinase(CK),creatine kinase-MB(CK-MB)and troponin T(cTnT)between the two groups(P>0.05).At T1,T2,T3 and T4,the levels of CK,CK-MB and cTnT in the study group were better than those in the control group,and the differences were statistically significant(P<0.05).Conclusion:The goal-directed fluid therapy is effective in ectopic pregnancy rupture complicated with hemorrhagic shock,which can increase the effective volume load,protect the myocardial function,and improve the level of related indexes of myocardial enzyme and provide a guarantee for prognosis.