摘要
目的探讨脉搏指示持续心排血量(PICCO)监测下早期目标导向镇静(EGDS)与标准镇静(STDS)对急诊重症监护病房(E1CU)机械通气患者血流动力学的影响。方法以长沙市中心医院16例行PICC0监测的机械通气患者为研究对象,随机分为右美托咪定为基础的E GDS组和咪达唑仑或丙泊酚的STDS组,观察两组患者一般资料及急性生理与慢性健康状况评分(APACHE Ⅱ评分)、器官功能衰竭评分(SOFA评分);记录给药前及达到目标镇静后的心率(H R)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、中心静脉压(CVP)、每搏童指数(SVI)、全身血管阻力指数(SVRI)等血流动力学指标。结果EGDS组与STDS组一般资料及APACHE Ⅱ评分、SOFA评分差异无统计学意义(P>0.05);在达到目标镇静后EGDS与STDS都对血流动力学指标HR、SBP、DBP、MAP、CVP、SVI有影响,差异有统计学意义(P<0.05);EGD S组与STDS组相比,EGDS对HR、SBP、D BP、MAP、SVI影响更显著,差异有统计学意义(P<0.05),STDS对CVP影响更显著,差异有统计学意义(P<0.05);两组对SVR1的影响差异无统计学意义(P>0.05)。结论EGDS与STDS都对血流动力学有影响,且EGDS可能对血流动力学影响更明显。
Objective To explore the effects of early goal-directed sedation(EGDS)and standard sedation(STDS)on hemodynamics in patients with mechanical ventilation in EICU under pulse indicator continous cardiac output(PICCO)monitoring.Methods Sixteen patients with mechanical ventilation who underwent PICCO monitoring in Changsha Central Hospital were randomized to dexmedetomidine-based groug(EGDS)and standard sedation with midazolam or propofol group(STDS).The general data and acute physiology and chronic health status(APACHE Ⅱ)score and sequential organ failure assessment(SOFA)score were observed.The heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),central venous pressure(CVP),stroke volume index(SVI)and systemic vascular resistance index(SVRI) were recorded before and after the target sedation.Results There were no significant differences between the EGDS group and the STDS group in terms of general data and APACHE Ⅱ scores and SOFA scores(P>0.05).After reaching the target sedation,both EGDS and STDS had an effect on hemodynamic parameters including HR,SBP,DBP,MAP,CVP,SVI and SVRI,the difference was statistically significant(P<0.05).Compared with STDS group,EGDS had more significant effects on HR,SBP,DBP,MAP and SVI,and the difference was statistically significant(P<0.05).The effect of STDS on CVP was more significanl,and the difference was statistically significant(P<0.05).There was no significant difference between llie two groups in SVRI(P>0.05).Conclusion Both EGDS and STDS had an effect on hemodynamics,and EGDS may have a more obvious effect on hemodynamics.
作者
龙勇
李长罗
汤丰宁
袁锋
李华
杨贵芳
LONG Yong;LI Changluo;TANG Fengning;YUAN Feng;LI Hua;YANG Guifang(Department of Emergency,Changsha Central Hospital,Changsha 410000,China)
出处
《中国急救复苏与灾害医学杂志》
2019年第12期1160-1163,共4页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
湖南省医药卫生计划项目(B2017150)。
关键词
脉搏指示连续心排血量监测
镇静
机械通气
血流动力学
Pulse indicator continous cardiac output
Sedation
Mechanical ventilation
Hemodynamics
