床旁超声心动图评价心功能不全患者呼吸机撤离失败原因
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摘要
目的探讨床旁超声心动图评价心功能不全患者呼吸机撤离失败的原因。方法选择2013年4月至2015年7月该院60例行呼吸机治疗的心功能不全患者,按呼吸机撤机成功与否将其分为研究组与对照组,各30例,前者呼吸机撤机成功,后者呼吸机撤机失败。采用床旁超声心动图检测系统自动输出心率(HR)、左室舒张期容积(EDV)、收缩期容积(ESV)、射血分数(EF),16节段达到峰值时间的最大时间差(Tmsv16-Dif)与标准差(Tmsv16-SD),以及峰值射血率(PER)与峰值充盈率(PFR)。结果研究组HR、EF值明显低于对照组(P<0.05),EDV、ESV值明显高于对照组(P<0.05);2组PER、PFR值比较,差异无统计学意义(P>0.05),研究组Tmsv16-SD、Tmsv16-SD、Tmsv16-SD%、Tmsv16-SD%值明显高于对照组(P<0.05)。结论床旁超声心动图能较准确地反映心功能不全患者的病情,并为呼吸机撤离失败的原因提供指导,具有临床应用价值。
Objective To investigate the value of bedside echocardiography on evaluating the reason of ventilator weaning failure in patients with cardiac insufficiency.Methods 60 cases patients with cardiac insufficiency treated by ventilator from April 2013 to July 2015 were divided into research group and control group according to the ventilator weaning success or not,30 cases in each group.The former was the group whose ventilator weaning success,and the latter was the group whose ventilator weaning Heart rate(HR),left ventricular diastolic volume(EDV),systolic volume(ESV),ejection fraction(EF),maximum time segment L6 peak time difference(Tmsv16-Dif)and standard deviation(Tmsv16-SD),and peak ejection rate(PER)and peak filling rate(PFR)were detected by bedside echocardiography system.Results HR and EF in the research group were significantly lower than those in the control group(P<0.05),while EDV and ESV were significantly higher than those in the control group(P<0.05).There were not significant differences on PER and PFR between the two groups(P>0.05),but Tmsv16-SD,Tmsv16-SD,Tmsv16-SD% and Tmsv16-SD% in the research group were significantly higher than those in the control group(P<0.05).Conclusion Bedside echocardiography can reflect the condition of patients with cardiac insufficiency accurately,and can provide guidance to find the reason of ventilator weaning failure,which has a high clinical value.
Objective To investigate the value of bedside echocardiography on evaluating the reason of ventilator weaning failure in patients with cardiac insufficiency.Methods 60 cases patients with cardiac insufficiency treated by ventilator from April 2013 to July 2015 were divided into research group and control group according to the ventilator weaning success or not,30 cases in each group.The former was the group whose ventilator weaning success,and the latter was the group whose ventilator weaning Heart rate(HR),left ventricular diastolic volume(EDV),systolic volume(ESV),ejection fraction(EF),maximum time segment L6 peak time difference(Tmsv16-Dif)and standard deviation(Tmsv16-SD),and peak ejection rate(PER)and peak filling rate(PFR)were detected by bedside echocardiography system.Results HR and EF in the research group were significantly lower than those in the control group(P<0.05),while EDV and ESV were significantly higher than those in the control group(P<0.05).There were not significant differences on PER and PFR between the two groups(P>0.05),but Tmsv16-SD,Tmsv16-SD,Tmsv16-SD% and Tmsv16-SD% in the research group were significantly higher than those in the control group(P<0.05).Conclusion Bedside echocardiography can reflect the condition of patients with cardiac insufficiency accurately,and can provide guidance to find the reason of ventilator weaning failure,which has a high clinical value.
引文
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[9]王红军,于洪涛,贾金广,等.34例医院获得性肺炎患者呼吸机撤离困难原因分析[J].中国现代医学杂志,2014,30(15):60-63.
[10]吴敬医,张霞,王箴,等.超声心动图评价感染性休克患者液体反应性的临床研究[J].中华危重病急救医学,2014,26(1):36-40.
[11]魏颖,张波,刘怡,等.床旁超声心动图诊断射频消融术后心脏左心室心肌夹层破裂1例[J].中国介入心脏病学杂志,2016,24(3):171-172.
[2]GUERET P,KHALIFE K,JOBIC Y,et al.Echocardiographic assessment of the incidence of mechanical complications during the early phase of myocardial infarction in the reperfusion era:a French multicentre prospective registry[J].Arch Cardiovasc Dis,2008,101(1):41-47.
[3]李庆波,刘少玲,洪蝶玫,等.急性左心功能不全患者无创呼吸机应用过程不适原因分析及护理对策[J].护理实践与研究,2013,13(15):13-15.
[4]王守君,王世富,翟萍,等.床旁超声心动图监测重症患者血容量及心脏功能的临床研究[J].临床超声医学杂志,2016,3(5):200-202.
[5]OTERO R,ORIBE M,BALLAZ A,et al.Echocardiographic assessment of pulmonary arterial pressure in the follow-up of patients with pulmonary embolism[J].Thromb Res,2011,127(4):303-308.
[6]LEVITT M A,JAN B A.The effect of real time 2-D-echocardiography on medical decision-making in the emergency department[J].J Emerg Med,2002,22(3):229-233.
[7]杨靓,张向阳,吴春波,等.急诊床旁超声心动图在急重症心血管疾病中应用[J].中华实用诊断与治疗杂志,2014,28(3):284-285.
[8]崔楠.床旁超声心动图评价心功能不全患者呼吸机撤机失败的临床分析[J].影像技术,2014,5(2):43-45.
[9]王红军,于洪涛,贾金广,等.34例医院获得性肺炎患者呼吸机撤离困难原因分析[J].中国现代医学杂志,2014,30(15):60-63.
[10]吴敬医,张霞,王箴,等.超声心动图评价感染性休克患者液体反应性的临床研究[J].中华危重病急救医学,2014,26(1):36-40.
[11]魏颖,张波,刘怡,等.床旁超声心动图诊断射频消融术后心脏左心室心肌夹层破裂1例[J].中国介入心脏病学杂志,2016,24(3):171-172.