摘要
目的探讨无创血流动力学监测系统(NICaS)对中-重度急性百草枯中毒(APP)患者血流动力学的临床指导价值。方法选取2019年1月至2020年7月入住我院急诊科的中-重度急性百草枯农药中毒(APP)患者102例,采用前瞻性研究,根据数字表法将患者随机分为无创血流动力学组(NICaS组)36例;经肺热稀释法测定组(Picco组)32例;经验治疗组(经验组)34例。分析3组患者相关血流动力学情况、病死率、并发症的关系。结果NICaS组、Picco组、经验组患者年龄、性别构成比、体质量指数、心率、收缩压、无治疗期及入院急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ)评分差异无统计学意义(P>0.05)。与经验组比较,NICaS组、Picco组APP患者的住院病死率较低,差异有统计学意义(P<0.05)。NICaS方法和Picco方法取同一时间点测得心排量(CO)和外周血管阻力指数(SVRI)有相关性,在2.7~6.8 L/min(r=1.000,P<0.001),在520~2367 dyn·s·cm^-5·m^2(r=1.000,P<0.001)区间的相关性较强。Bland-Altmen分析Picco与NICaS所测得CO具有93.75%的一致性(P=0.278),SVRI具有96.88%的一致性(P=0.579)。与经验组比较,NICaS组及Picco组患者平均每日输液量、每日输注胶体液量均较低,差异有统计学意义(P<0.05),各组间比较,首次获得心排量均有差异,差异有统计学意义(P<0.05)。结论使用无创血流动力学监测系统可在中-重度APP患者抢救中有效、快捷、安全的对血流动力学指标进行监测。
Objective The aim of this study was to investigate the clinical value of non-invasive hemodynamics monitoring system(NICaS)in hemodynamics of patients with moderate to severe acute paraquat pesticide(APP).Methods A total of 102 patients with moderate to severe APP admitted to the emergency department in our hospital from January 2019 to March 2020 were enrolled and randomly divided into non-invasive hemodynamic group(NICaS group,36 cases),lung thermal dilution group(Picco group,32 cases)and empirical treatment group(34 cases).The relationships among hemodynamics,survival rate and complications were analyzed.Results The patients age,sex ratio,body mass index(BMI),heart rate,systolic blood pressure,treatment period and admitted to hospital with acute physiology and chronic health evaluationⅡ(APACHEⅡ)score were all no statis-tical difference among three groups(P>0.05).Compared with the experience group,the in-hospital mortality of APP patients in NICaS group and Picco group was significantly lower(P<0.05).The Cardiac output(CO)was significantly correlated with peripheral vascular resistance index(SVRI)at the same time point measured by NICaS and Picco methods.This correlation was more obvious in the interval of 2.7~6.8 L/min(r=1.000,P<0.001)and 520~2367 dyn·s·cm^-5·m^2(r=1.000,P<0.001).Bland-altmen analysis showed that the consistency of CO measured by Picco and NICaS was 93.75%(P=0.278)and that of SVRI was 96.88%(P=0.579).Compared with the experience group,the average daily infusion volume and daily colloid infusion volume of patients in NICaS group and Picco group were lower and the differences were statistically significant(P<0.05).Comparison between the groups showed that the first cardiac output was statistically different(P<0.05).Conclusion The use of noninvasive hemodynamic monitoring system could effectively,quickly and safely monitor hemodynamic indexes in the rescue of patients with moderate to severe APP.
作者
高珣
王玉凤
肖青勉
朱倩倩
王璞
王维展
GAO Xun;WANG Yufeng;XIAO Qingmian;ZHU Qianqian;WANG Pu;WANG Weizhan(Harrison International Peace Hospital Affiliated to Hebei Medical University,Hengshui 053000,China)
出处
《实用医学杂志》
CAS
北大核心
2020年第21期2947-2952,共6页
The Journal of Practical Medicine
基金
河北省医学科学研究课题项目(编号:20200406)。
