微创血流动力学监测在心源性休克患者复苏治疗中的作用

目的:探讨FloTrac/Vigileo微创血流动力学监测技术在心源性休克患者复苏治疗中的应用。方法:选择19例入住ICU的心源性休克患者,采用FloTrac/Violeo微创血流动力学监测技术对患者进行床旁血流动力学监测,并指导液体复苏。观察液体容量复苏期间血流动力学指标的动态变化及疾病的转归。结果:19例患者,复苏72 h后中心静脉压(CVP)均较前明显下降,CI、ScvO2明显升高(均P0.05)。其余指标无显著性差异。入院第28 d,13例患者复苏成功后转入普通病房,无严重并发症。6例患者因严重心力衰竭死亡。复苏后72 h存活组与死亡组比较,HR、MAP、CVP、CI、SVRI、ScvO2指标差异均有统计学意义。其中存活组复苏前后比较,CVP较前明显下降,CI、ScvO2明显升高(均P0.05)。死亡组MAP、CVP较前明显下降,CI、ScvO2明显升高(均P0.05)。结论:FloTrac/Vigileo微创血流动力学监测技术能有效地通过监测心源性休克患者的容量负荷及全身血流灌注情况,以指导临床进行液体复苏,预防并发症的发生。

Effect of micro-invasive hemodynamic monitoring in resuscitation of patients with cardiogenic shock

Objective ： To explore the application of FloTrac/Vigileo micro-invasive hemodynamic monitoring in resuscitation of patients with cardiogenic shock. Methods ： Nineteen patients with cardiogenic shock admitted in ICU were enrolled. Each subject was tested by the FloTrac/Vigileo micro-invasive hemodynamic monitor at bedside and the resuscitation was directed according to the hemodynamic parameters. The dynamic changes of hemodynamic parameters during the fluid resuscitation and the outcome of diseases were observed. Resuhs： With the application of micro-invasive hemodynamic monitor in 19 patients for 72 hours resuscitation, CVP was lower, CI, ScvO2 were significantly higher （ P 〈 0.05 ）. The other hemodynamic parameters showed no significant change. 13 patients were transferred to the general ward after successful resuscitation when admitted for 28 days, and without severe complications. 6 patients died due to severe heart failure. Compared with those of survival group, the hemodynamic parameters such as HR, MAP, CVP, CI, SVRI and ScvO2 showed significant differences after 72 hours of resuscitation. In survival group, the hemodynamic parameter CVP in 72 hours was decreased significantly after resuscitation. In contrast, CI and ScvO2 were significantly higher than before （ P 〈 0.05 ）. In death group, the MAP and CVP were significantly decreased while CI and ScvO2 were significantly increased （ P 〈 0.05 ）. Conclusions ： FloTrac/ Vigileo micro-invasive hemodynamic monitoring technique can effectively evaluate the volume load and systemic blood perfusion of patients with cardiogenic shock in order to guide clinical fluid resuscitation accurately and to prevent the complications.