摘要
目的探讨胸腔内血容量指数(ITBVI)、全心舒张末期容量指数(GEDVI)在多发伤患者容量状态评估中的意义。方法选择26例因多发伤入住ICU的患者,通过PICCO(pulse-indicated conitinuous cardiac output)技术(PULSION公司,德国)即经肺热稀释方法和脉搏轮廓分析法监测MAP、CI、SI、SV、EVLWI、ITBVI、GEDVI,记录液体复苏前后的上述指标。同时,监测复苏前、复苏24h后动脉血气分析,记录每次的乳酸及碱剩余值。结果复苏前与复苏终点相比,ITBVI、GEDVI与SI有显著相关性,r分别为0.783、0.774(P<0.01);HR与SI似呈负相关,r=-0.309(P>0.05);CVP、MAP与SI相关系数r分别为0.104、-0.025(P>0.05),相关性较差;复苏后的胸腔内血容量变化(ΔITBVI)与每搏输出量指数变化(ΔSI)有显著相关性,r=0.654(P<0.01);全心舒张末期总容量指数变化(ΔGEDVI)与ΔSI,显著正相关,r=0.558(P<0.05);而ΔCVP、ΔHR、ΔMAP与ΔSI相关系数r分别为-0.042、-0.382、-0.382(P>0.05),相关性较差。存活组与死亡组相比,液体复苏前乳酸及碱剩余水平差异无统计学意义(P>0.05),液体复苏24h后,死亡组乳酸及碱剩余水平显著高于存活组(P<0.01);存活组液体复苏24h后乳酸及碱剩余水平明显低于复苏前(P<0.01),死亡组液体复苏前后乳酸及碱剩余水平差异无统计学意义(P>0.05)。结论ITBVI、GEDVI及其容量复苏后的变化能准确、可靠地评估患者容量状态,对多发伤患者的液体管理具有重要价值。
Objective To study the significance of using intrathoracic blood volume index （ITBVI） and global end-diastolic volume index（GEDVI） to assess volume status in multi-trauma patients. Methods 26 multi-trauma patients admitted into intensive care unit（ICU） were involved in the prospective and control study. MAP,CI,SI,SV,EVLWI,ITBVI,GEDVI were monitored through transpulmonary thermodilution PICCO technique. Collect the data before and after fluid resuscitation. Meanwhile, test the artery blood and gas, and record the value of blood lactate（LAC） and base excess（BE） before and 24 hours after fluid resuscitation. Results Before fluid resuscitation and at the fluid resuscitation endpoint, significant correlation was found between SI and ITBVI, GEDVI, （r= 0. 783, 0. 774, P〈0. 01 ）, negative but insignificant correlation between HR and SI（ r=- 0. 309, P〉0.05）, no significant correlation between SI and CVP,MAP. After fluid resuscitation, significant correlation was found between △SI and △ITBVI（r= 0. 654, P〈0. 01 ）, △GEDVI（ r= 0. 558, P〈0. 05）, no significant correlation between △SI and ACVP,AHR,AMAP（ r= -0. 042, -0. 382, -0. 382; P〉0. 05）. Before fluid resuscitation, there＇ s no significance in LAC and BE between survival group and death group. 24h after fluid resuscitation, LAC and BE of death group are higher than those of survival group（ P〈0. 01 ）. In survival group, LAC and BE were significantly lowered at 24h after fluid resuscitation. No signifleant change of LAC and BE is found after fluid resuscitation in death group（ P〉O. 05 ）. Conclusion ITBVI ,GEDVI and their changes after fluid resuscitation can be used to accurately and dependably to assess the volume status of multi-trauma patients, and are useful for their fluid management.
出处
《四川医学》
CAS
2010年第1期42-44,共3页
Sichuan Medical Journal
关键词
胸腔内血容量指数
全心舒张末期容量指数
多发伤
血流动力学
液体复苏
intrathoracic blood volume index （ITBVI）
global end-diastolic volume index （GEDVI）
multi-trauma
hemodynamics
fluid resuscitation
