压力记录分析法指导循环管理在供体维护中的应用价值

Application value of pressure recording analytical method in circulation maintenance of organ donors

目的探讨压力记录分析法(PRAM)指导循环管理在供体器官维护中的临床价值。方法50例脑死亡捐献者随机均分为两组,C组根据中心静脉压(CVP)、连续有创动脉压监测指导液体复苏、血管活性药物及强心药物的使用,P组根据PRAM血流动力学监测指标指导相关治疗。记录两组入院时和捐献时的CVP、HR、MAP、中心静脉血氧饱和度、血乳酸、B型脑利钠肽(BNP)、肌钙蛋白I(cTnI)、氧合指数(FiO2/PaO2)、SCr、ALT、AST、TBil;记录两组液体入量、血管活性药物及强心药物的使用情况及捐献情况。结果入院时两组血流动力学指标及血管活性药物使用情况均无统计学差异(P>0.05)。与入院时相比,捐献时P组HR、血乳酸、BNP、cTnI、SCr、ALT、AST降低,尿量增加,多巴胺及去甲肾上腺素用量减少(P<0.05)。与C组相比,捐献时P组CVP、液体总正平衡量、BNP、cTnI、AST降低,FiO2/PaO2升高,多巴酚丁胺使用率增加,多巴胺及去甲肾上腺素用量减少(P<0.05)。P组心脏捐献比例高于C组(P<0.05)。结论PRAM用于指导脑死亡供体的维护,有利于精准的液体管理,指导血管活性药物的应用,更好地维持捐献器官的功能。

Objective To explore the clinical value of the pressure recording analytical method(PRAM)system in the circulation maintenance of the organ donors.Methods Fifty organ donors with brain death were equally randomized into two groups.The fluid resuscitation and vasoactive and cardiotonic drugs use in group C were guided by CVP and continuous invasive arterial pressure monitoring,which in group P were guided by PRAM.The indexes recorded at the times of admission(T1)and donation(T2)included HR,MAP,CVP,central venous oxygen saturation,blood lactic acid,B-type natriuretic peptide(BNP),cardiac troponin I(cTnI),FiO2/PaO2,SCr,ALT,AST,TBil.The fluid intake,dosages of vasoconstrictor drug(dopamine and norepinephrine)and inotropic drug(dobutamine),and organ donation were recorded as well.Results There were no significant differences in hemodynamics and vasoactive drug use between the two groups at admission(P>0.05).Compared with T1,the HR,blood lactic acid,BNP,cTnI,SCr,ALT,AST,and the dosages of dopamine and norepinephrine were decreased,while urine volume was increased at T2 in group P(P<0.05).Compared with group C,the CVP,cumulative fluid positive balance,BNP,cTnI,AST and dosages of dopamine and norepinephrine were decreased,while FiO2/PaO2 and the proportion of using dobutamine were increased in group P(P<0.05).The proportion of heart donation in group P was more than that in group C(P<0.05).Conclusion PRAM-guided maintenance of brain dead donors is beneficial to getting more accurate fluid management and vasoconstrictor use and better maintaining the functions of the donated organs.