心肺联合超声与PICCO对急危重症患者监测结果的相关性

doi:10.3877/cma.j.issn.2096-1537.2021.02.003

中华重症医学电子杂志 ›› 2021, Vol. 07 ›› Issue (02) : 110 -114. doi: 10.3877/cma.j.issn.2096-1537.2021.02.003

临床研究

心肺联合超声与PICCO对急危重症患者监测结果的相关性

方一¹, 吕迪¹, 周海东¹, 陈远卓¹, 孙肖肖¹, 庄育刚¹^,^†(

)

^1. 200072　同济大学附属上海第十人民医院急诊科

收稿日期:2020-06-16 出版日期:2021-05-28
通信作者: 庄育刚
基金资助:
国家自然基金委面上项目(81971804); 上海卫健委面上项目(201740240)

A correlation between combined cardiopulmonary ultrasound and pulse index continuous cardiac output monitoring in critically ill patients

Yi Fang¹, Di Lyu¹, Haidong Zhou¹, Yuanzhuo Chen¹, Xiaoxiao Sun¹, Yugang Zhuang¹()

^1. Department of Emergency, Shanghai 10th People's Hospital Affiliated to Tongji University, Shanghai 200072, China

Received:2020-06-16 Published:2021-05-28
Corresponding author: Yugang Zhuang

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目的

分析心肺联合超声与脉搏指数连续心输出量（PICCO）对急危重症患者监测结果的相关性。

方法

采用前瞻性自身对照研究方法，选取2020年4至6月入住上海市第十人民医院急诊ICU的患者，采用PICCO监测患者心输出量（CO）和血管外肺水指数（ELWI），同时使用心肺联合超声监测患者CO、左心室流出道（LVOT）血流的速度时间积分（VTI）和肺部超声B线情况，分析两种方法监测结果的相关性。

结果

共入选41例患者，其中男∶女为26∶15，年龄（73.6±8.85）岁。超声和PICCO两种方法下监测的CO值结果比较，差异无统计学意义［（4.87±1.04）L/min vs （5.11±1.05）L/min，t=1.01，P=0.316］，Pearson相关性分析提示两者之间存在显著相关性（r=0.911，95%CI：0.82~0.96，P＜0.001）；肺部超声B线与ELWI存在显著相关性（r=0.770，95%CI：0.58~0.88，P＜0.001）。

结论

心肺联合超声监测急危重症患者与PICCO监测结果存在相关性。

关键词: 急危重症监测, 脉搏指数连续心输出量, 心肺联合超声

Objective

To analyse the correlation of combined cardiopulmonary ultrasound and pulse index continuous cardiac output (PICCO) monitoring in critically ill patients.

Methods

Prospective self-controlled study was used. Patients who need hemodynamic monitoring from April to June 2020, Shanghai Tenth People's Hospital Emergency Intensive Care patients were enrolled. All patients received PICCO monitoring to get cardiac output (CO) and vascular lung water index (ELWI). Meanwhile, cardiopulmonary ultrasonic automatic monitoring was performed to get CO, the left ventricular outflow blood flow velocity time integral (VTI) and lung ultrasound B line.

Results

A total of 41 patients were enrolled, the male/female ratio was 26∶15 and average age was (73.6±8.85) years old. There was no statistical difference between PICCO and echocardiography in CO (t=1.01, P=0.316) with a correlation of 0.911 (95%CI=0.82-0.96, P＜0.001). Similarly, a correlation between pulmonary ultrasound and ELWI was also found (r=0.770, 95%CI=0.58-0.88, P＜0.001).

Conclusion

The monitoring results of critically ill patients between combined cardiopulmonary ultrasound and PICCO has correlation.

Key words: Acute critical illness monitoring, Pulse index continuous cardiac output, Combined cardiopulmonary ultrasound

图1 自动识别测量VTI和CO系统。图a在胸骨旁长轴标准三腔心界面测定LVOT 直径；图b、c、d在标准心尖五腔切面，利用人工智能优化脉冲多普勒盒的位置，记录4 s的多普勒频谱，跟踪VTI的轮廓，记录所有VTI，自动识别并量化VTI和CO

图2 肺部超声自动评分系统。图a评分为0分（B线0条），图b评分为0分（B线1条），图c评分为0分（B线2条），图d评分为1分（B线3条），图e评分为1分（B线4条），图f评分为2分（B线≥5条）

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