每搏量变异度与中心静脉压监测在老年脓毒性休克患者液体复苏治疗中指导作用的比较  

Comparison analysis of stroke volume variation and central venous pressure monitoring in fluid resuscitation of elderly patients with septic shock

作　　者：叶宏伟[1] 许春阳[1] 冯玉峰[1] 郑峰[1] 

机构地区：[1]常熟市第一人民医院重症医学科,江苏常熟215500

出　　处：《临床急诊杂志》2014年第4期210-213,共4页Journal of Clinical Emergency

基　　金：苏州市科技发展项目(No:SYSD20100014)

摘　　要：目的:比较每搏输出量变异(SVV)监测与中心静脉压(CVP)监测指导老年脓毒性休克患者早期液体复苏疗效。方法:70例患者随机分为2组,在接受常规脓毒性休克治疗基础上,分别采取SVV监测及CVP监测的方法指导早期液体复苏,将2组患者液体复苏后3、6、24h乳酸(LAC)、脑钠肽(BNP)、血管外肺水(EVLWI)、补液量进行比较,同时评价比较两组患者血管活性药物平均使用时间及28d生存率。结果:液体复苏后3、6h时SVV组补液量较CVP组更多,LAC下降更快(P<0.05),乳酸清除率增多,而BNP、EVLWI无明显差异;24hCVP组较SVV组补液增多,BNP及EVLWI升高明显(P<0.05),而两组患者的LAC差异无明显统计学意义。SVV组患者使用血管活性药物平均时间较CVP组明显缩短,28d生存率则增加(P<0.05)。结论:在老年脓毒性休克患者的早期液体复苏治疗中,与CVP传统指标相比,SVV指导补液更为安全、有效。Objective：To assess the effect of fluid treatment in elderly patients with septic shock guided by the way of monitoring the stroke volume variation（SVV）and central venous pressure（CVP）.Method：Seventy elderly patients with septic shock were enrolled in ICU of Changshu 1st Hospital from July 2010 to July 2013 and randomly divided into CVP group and SVV group（35 each）.All patients received treatment based on conventional septic shock.Fluid treatment was given to the patients.The lactate（LAC）,brain natriuretic peptide（BNP）,extravascular lung water（EVLWI）,total infusion amount of patients in the two groups were recorded serially in the first 24 hours,and they were compared between the two groups.The mean time of vasopressors application and survival rate of the patients in two groups on 28 days were also recorded.Result：There were no significant differences between the groups with respect to base-line characteristics.During the interval from 3 to 6 hours,the SVV group had a significantly more in total infusion amount and the rate of lactate decrease（P＆lt;0.05）,no significant differences in BNP and EVLWI;During the first 24 hours,the CVP group had a significantly more in total infusion amount.Significantly high in BNP and EVLWI（P＆lt;0.05）,no significant differences in lactate concentration.Compared with SVV group,the CVP group had significantly high mean time of vasopressors application and low 28 days survival rate of the patients（P＆lt;0.05）.Conclusion：Compared with the traditional monitoring indicators CVP,the way of monitoring the stroke volume variation（SVV）is safer and more effective in the fluid treatment of elderly patients with severe sepsis.

关 键 词：每搏量变异度 中心静脉压 老年 脓毒性休克 液体复苏 

分 类 号：R459.7[医药卫生—急诊医学]