体位改变对脑卒中卧床患者血流动力学的影响

关键词：心输出量检测系统  脑卒中  体位改变  血流动力学

Keywords:physioflow  stroke  body position changes  haemodynamic

摘要：

      摘要 目的：研究平卧位、站立位两种体位改变对脑卒中卧床患者心率、血压、左室排血功能、心肌收缩功能、心脏前负荷、后负荷等血流动力学参数的影响。 方法：采用观察性研究方法，利用无创心输出量检测系统，监测30例脑卒中卧床患者和20例正常受试者在平卧位、站立位两种不同体位改变时的心率（HR）、平均动脉压（MABP）、心输出量指数（CI）、每搏输出量（SV）、心收缩力指数（CTI）、左心做功指数（LCWI）、前负荷率（EDFR）、外周血管阻力（SVR）。每个体位连续监测2min，取以上参数的平均值作为观察结果。 结果：①平卧位时脑卒中卧床患者的SV、CTI较正常受试者显著下降（P<0.01），HR显著上升（P<0.01）；②脑卒中卧床患者在不同体位下的比较：HR、SV、CI、CTI、LCWI均呈现平卧位<站立位（P<0.01），且站立位HR升高最大幅度10次/分左右（76.36±8.54 VS 86.12±12.57）；SVR比较结果为平卧位>站立位（P<0.01）；③正常受试者不同体位间的比较：HR表现为平卧位<站立位（P<0.01）；SV表现为平卧位>站立位（P<0.01）；CTI、LCWI、SVR比较无差别；④在平卧位→站立位变化时：HR在两组间均出现持续上升趋势；SV在正常受试者中呈下降趋势而脑卒中卧床患者却呈上升趋势。 结论：脑卒中卧床患者心排量较正常人群下降，从平卧位到站立位的体位改变对脑卒中卧床患者心血管反应有明显的影响，而且这种体位改变是一种安全有效的辅助训练心功能的方法。

Abstract:

      Abstract Objective:To investigate effects of two body positions changes，including supine and standing positions，on haemodynamic (heart rate,blood pressure,left ventricle ejection function,cardiac systolic function,cardiac preload,cardiac postload) in bedridden patients with stroke. Method:Thirty bedridden patients with stroke and 20 normal subjects were enrolled in the study and performed two body positions (supine and standing), heart rate（HR）,mean arterial blood pressrue（MABP）,cardiac output index（CI）,stroke volume（SV）,contractility index（CTI）,left cardiac work index（LCWI）,early diastolic filling ratio（EDFR）,systemic vascular resistance（SVR）were recorded by physioflow. Each position was continuously monitored for 2 minutes, and the mean value of each parameters was taken as the final result. Result:①SV and CTI of bedridden patients with stroke decreased significantly compared with normal subjects at supine position (P<0.01), while HR increased significantly (P<0.01)； ②Comparison of bedridden patients with stroke in different body positions: The HR,SV,CI,CTI and LCWI were increased significantly when from supine to standing(P<0.01), while SVR were decreased (P<0.01), the HR were increased by about 10 beats/min（76.36±8.54 VS 86.12±12.57）；③Comparison of normal subjects in different body positions: the HR increased significantly when from supine to standing（P<0.01）, accompanied by a reduction in SV(P<0.01), and there were no significant difference in CTI,LCWI and SVR； ④The HR was increased in both groups when from supine to standing, the SV decreased in normal subjects but increased in bedridden patients with stroke. Conclusion: The cardiac output of bedridden stroke patients was lower than that of normal people. Transforming from supine to standing position not only has a significant responses on haemodynamic in bedridden stroke patients, but aslo is a safe and effective way to improve heart function.