目的 探讨应用体外模拟预混法在老年危重患者更换多种血管活性药物管路中维持血流动力学稳定的临床效果。方法 选取2016-06至2020-10解放军总医院第二医学中心心内科收治的98例老年危重患者,随机分为治疗组和对照组,每组49例。对照组采用常规护理方法更换输液管路,治疗组采用“体外模拟预混法” 更换输液管路。记录两组患者更换管路前、更换管路后1、3、5、10 min的血压及心率,并对血压、心率的波动值及恢复时间进行比较。结果 治疗组更换管路后3、5、10 min收缩压波动值[(15.55±5.59)mmHg、(6.59±1.74)mmHg、(5.02±1.51)mmHg]显著低于对照组[(47.02±6.36)mmHg、(25.51±5.60)mmHg、(10.69±4.10)mmHg],差异有统计学意义(P＜0.05)。更换管路后3、5、10 min舒张压及心率波动值在两组间差异均有统计学意义(P＜0.05);10 min内血压心率恢复的发生率治疗组(95.3%)高于对照组(63.3%),差异有统计学意义(P＜0.05)。结论 应用“体外模拟预混法”为输注血管活性药物的老年危重患者更换输液管路,可有效减小血压、心率的波动,缩短管路更换后血压、心率恢复的时间,维持血流动力学稳定。
Abstract
Objective To evaluate the clinical effect of the in vitro simulation premixed method during the maintenance of hemodynamic stability when multiple vasoactive drugs are replaced among elderly and critically ill patients. Methods Between June 2016 and October 2020, 98 elderly and critically ill patients in our hospital were randomly divided into the premixed group and control group, with 49 cases in each. In the control group, venous fluid and vasoactive drugs were correctly arranged and connected with the three-way connector, the old tube was removed after connecting the extension tube for exhaust, and the new tube was connected with the venous catheter. In the premixed group, the in vitro simulation premixed method was adopted, which involved connecting and running the micro pump to premix the drug for 3 minutes before replacing the tube. Blood pressure and heart rate were measured before tube replacement and 1 min, 3 min, 5 min and 10 min after replacement in the two groups. The fluctuations and recovery time of blood pressure, heart rate before and after replacement were recorded for three consecutive days. Results There were significant differences in systolic blood pressure at 3 min,5 min,10 min after replacement[(15.55±5.59)mmHg,(6.59±1.74)mmHg and(5.02±1.51)mmHg]in the premixed group versus[(47.02±6.36)mmHg,(25.51±5.60)mmHg and(10.69±4.10)mmHg]in the control group. There was no significant difference between the two groups at 1 min after replacement, but there was significant difference at 3 min, 5 min and 10 min after replacement. Conclusions The in vitro simulation premixed method, when used to replace the infusion tube for the elderly and critically ill patients treated with vasoactive drugs, can effectively reduce the fluctuations of blood pressure and heart rate, shorten the recovery time of blood pressure and heart rate after tube replacement, and maintain the stability of hemodynamics.
关键词
老年 /
危重患者 /
血管活性药物 /
输液管路更换 /
微量泵
Key words
elderly /
critically ill patients /
vasoactive drugs /
replacement of infusion tubes /
micropumps
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基金
解放军总医院第二医学中心专项保健课题(NLBJ-2019004)
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