无创血流动力学监测在严重多发伤合并肺挫伤中的临床应用

目的 探讨无创血流动力学监测技术在严重多发伤合并肺挫伤液体复苏时的临床应用价值.方法 回顾性分析2011年1月-2012年3月收住ICU的严重多发伤合并肺挫伤患者24例.所有病例在常规心电监护基础上,应用BioZ胸电生物阻抗法,进行无创学流动力学监测,选择有代表性的心率（HR）、平均动脉压（MAP）、心脏搏出量（SV）、心输出量（CO）、胸液水平（TFC）、外周血管阻力（SVR）进行统计分析,指导液体复苏,记录患者复苏结局等相应的临床情况.结果 液体复苏前后,患者血流动力学监测示,在TFC与氧合指数方面,复苏前与复苏后相比,TFC增加及氧合指数下降差异不明显,无统计学意义（P〉0.05）;所有患者在复苏后,HR、MAP、SV、CO、SVR以及剩余碱水平均较复苏前明显改善,具有统计学意义（P〈0.05）.结论 无创血流动力学监测技术在严重多发伤合并肺挫伤液体复苏时发挥着重要作用,具有很好的临床指导价值,值得临床推广.

Application value of noninvasive hemodynamic monitoring in patients with severe multiple trauma combined with pulmonary contusion

Objective To evaluate the application value of noninvasive hemodynamic monitoring in patients with severe multiple trauma combined with pulmonary contusion during fluid resuscitation. Methods A total of 24 cases of severe multiple trauma combined with pulmonary contusion admitted to the ICU were retrospectively analyzed from 2011 January to 2012 March. Noninvasive hemodynamie mo-nitoring were taken to guide fluid resuscitation through the application of BioZ thoracic electrical bioimpedance on the basis of convention-al ECG monitoring. Levels of heart rate （HR） , mean arterial pressure （MAP） , cardiac stroke volume （SV） , cardiac output （CO） , tho-racic fluid level （TFC）, and external peripheral vascular resistance （SVR） were collected and statistically analyzed to evaluate the effi-ciency. Results All the patients were treated with fluid resuscitation and monitored by noninvasive hemodynamic monitoring. Hemody-namic indexes, such as HR, MAP, SV, CO, SVR and BE were improved significantly compared with those before treatment （P 〈 0.05 ）. On the other hand, the levels of TFC and PaO2/FiO2 in the patients post-fluid resuscitation showed no significant change compared with those before treatment （ P 〉 0.05 ）. Conclusion Noninvasive hemodynamie monitoring plays an important role in the therapy of fluid re-suscitation of patients with severe multiple injury combined with pulmonary contusion. It has good clinical value and is worth spreading in clinic.