无创血流动力学监测在急重症患者诊治中的应用

【摘要】目的探讨无创血流动力学监测对心源性和非心源性急重症患者的诊断及治疗价值。方法选取本院收治的85例急重症患者进行回顾性分析，入选患者均采用无创血流动力学监测，按照病因分为心源性组与非心源性组，比较两组患者无创血流动力学检测参数的差异，并分析该监测方式对治疗的指导意义。结果两组患者的心率（HR）、收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）比较差异均无统计学意义（P〉0．05）；心源性组患者心脏指数（CI）、心输出量（C0）每搏输出量（SV）、每搏指数（SI）、左室射血时间（LVET）、加速度指数（ACI）、左室做功（LCW）均显著低于非心源性组（P〈0．05）；同时，心源性组患者体血管阻力（SVR）、胸腔液体量（TFC）、收缩时间比率（STR）、预射血期（PEP）显著高于非心源性组（P〈0．05）。根据患者病因结合无创血流动力学参数指导治疗，心源性组患者给予强心、利尿等相关治疗，非心源性组给予抗感染、机械通气、改善。肾功能等治疗，85例患者存活69例，死亡16例。结论心源性急重症与非心源性急重症的血流动力学指标存在显著差异，可依据监测结果指导早期目标性治疗。

Application of noninvasive cardiac output monitoring in diagnosis and treatment of acute and critical illness

Objective To explore the value ofnoninvasive cardiac output monitoring in diagnosis and treat- ment of acute and critical illness. Methods Eighty-five patients with acute and critical illness were selected in this study retrospectively. All patients received noninvasive cardiac output monitoring. According to the cause of disease, these patients were divided into cardiac symptom group and non-cardiac symptom group. Comparison was made be- tween two groups in respects ofnoninvasive hemodynamic parameters and its clinical significance in guidance of clini- cal treatment was analyzed. Results There was no difference in HR, SBP, DBP, and MAP between two groups （P〉 0.05）. The CI, CO, SV, LVET, ACI, LCW in cardiac symptom group were lower than those in non-cardiac symptom group （P〈0.05）. Meanwhile, the SVR, TFC, STR, PEP in cardiac symptom group were higher than those in non-cardi- ac symptom group （P〈0.05）. After the clinical treatment based on different noninvasive hemodynamic parameters, 69 patients survived and 16 died. Conclusion Cardiac and non-cardiac acute and critical illness differ in hemodynamic parameters, and treatment in early stage is expected under the guidance of monitoring.