无创血流动力学监护系统在高危外科患者复苏治疗中的应用

Application of noninvasive hemodynamic monitoring on highrisk surgical patients in the early stages after emergency admission

目的 :探讨在急诊条件下早期应用无创血流动力学监护系统的必要性和可行性 ,评估其早期揭示循环功能不良和在早期高危急诊外科患者复苏治疗中的指导作用。方法 :用无创血流动力学监护系统监测 1 5 6例高危急诊外科患者 ,对其中 4 8例同时进行了有创血流动力学监护系统 (Swan Ganz法 )的观察 ,并将两种方法所得结果进行比较。结果 :无创血流动力学监护系统所获得的心排血量 (CO)和心脏指数 (CI)值与有创血流动力学监护系统所获得的值非常接近 ,在急诊条件下 ,r=0 .6 9,r2 =0 .87,P<0 .0 0 1 ;偏差和精确度为 (0 .6 2±0 .38) L· min- 1 · m- 2 。在 ICU条件下进一步比较两种方法所得结果 :r=0 .84 ,r2 =0 .93,P<0 .0 0 1 ;偏差和精确度为 (0 .36± 0 .1 5 ) L· m in- 1· m- 2。结论 :在急诊条件下应用无创血流动力学监护系统可显示创伤初期和复苏早期阶段的低血压、低 CI、低经皮氧张力 (Ptc O2 )、低血氧饱和度 (Sa O2 )和高经皮二氧化碳张力 (Ptc CO2 )的变化过程 ,并且为早期复苏治疗提供直观、可靠、连续性的依据 ,对预防由于长时间组织低血流量和低灌注所致的休克。

Objective: Pulmonary artery(PA) catheterization monitoring(SwanGanz) is usually not available to critically highrisk surgical patients before admission to ICU, where action to correct values derived from such monitoring may be too late. To explored the effect of noninvasive monitoring systems that allow hemodynamic monitoring during the early stages after trauma. Methods: The early temporal hemodynamic patterns after highrisk trauma with noninvasive monitoring systems was evaluated, and compared these to invasive PA monitoring. The study included 156 patients monitored shortly after admission to the emergency department . Results: The noninvasive impedance cardiac output estimations under extenuating emergency conditions were similar to those of the thermodilution method: r =0 69, r 2=0 87 , P <0 001 ; bias and precision were (0 62±0 38)L·min -1 ·m -2 . In ICU, these values improved further to: r =0 84, r 2=0 93, P <0 001 ; bias and precision were(0 36±0 15)L·min -1 ·m -2 . Monitoring revealed episodes of hypotension , low cardiac index, arterial hemoglobin desaturation, low transcutaneous oxygen and high transcutaneoua carbon dioxide tension, and low oxygen consumption during initial resuscitation. Low flow and poor tissue perfusion were more pronounced in nonsurvivors by both methods. Conclusion: Multicomponent noninvasive monitoring systems offer continuous online, realtime display of hemodynamic data, they allow early recognition of circulatory dysfunction. Such systems provide information similar to that provided by the invasive themodilution method, and are more effective and safer.