液体平衡和血管外肺水指数变化及腹内压变化对感染性休克预后的影响研究  

Effects of Fluid Balance,EVLWI and IAP on Prognosis of Septic Shock Patients

作　　者：张俭[1] 胡正祥[1] 洪许伟[1] 王白永[1] 

机构地区：[1]杭州师范大学附属医院重症医学科,浙江省杭州市310015

出　　处：《中国全科医学》2014年第17期1980-1983,共4页Chinese General Practice

摘　　要：目的分析液体平衡、血管外肺水指数（EVLWI）和腹内压（IAP）变化对感染性休克患者预后的影响。方法选择2011年3月—2012年8月杭州师范大学附属医院重症医学科收治的57例感染性休克患者,采集患者3d内的液体入量、尿量、脉搏指数连续心输出量（PICCO）及IAP。以存活28 d为界,将患者分为存活组（38例）和死亡组（19例）,分析两组患者液体平衡量的差异。分别以血管外肺水指数差值（ΔEVLWI）〈-3 ml/kg和腹内压差值（ΔIAP）〈-1 mm Hg（1 mm Hg=0.133 kPa）将患者分为效应组和非效应组,对比两组患者的病死率。结果存活组和死亡组患者入ICU 6 h内液体平衡量间差异无统计学意义（P〉0.05）,入ICU第1、2、3天总液体平衡量间差异有统计学意义（P〈0.0001）。存活组ΔEVLWI为（-3.91±1.21）ml/kg,死亡组ΔEVLWI为（-2.03±1.92）ml/kg,存活组ΔIAP为-1.0（-2.0～1.0）mm Hg,死亡组ΔIAP为1.0（0～2.0）mm Hg,两组ΔEVLWI和ΔIAP间差异有统计学意义（t=4.53、3.70,P〈0.05）。ΔEVLWI和ΔIAP与3 d内总液体平衡量间呈正相关关系（r=0.43,0.40,P〈0.05）;ΔEVLWI、ΔIAP效应组病死率明显低于非效应组（22%和55%,4%和53%）。结论感染性休克存活患者3 d内多出现液体负平衡,而死亡患者未出现液体负平衡,提示液体负平衡的出现能够改善患者预后,入ICU后3 d内ΔEVLWI减少3 ml/kg或ΔIAP减少1 mm Hg提示患者预后良好。Objective To analyze the effects of the changes of fluid balance,extravascular lung water index（EVLWI）,intra-abdominal pressure（IAP） on the prognoses of patients with septic shock（SS）.Methods The fluid intake,urine output,pulse index continuous cardiac output（PICCO） and IAP were collected in 57 SS patients admitted to Intensive Care Unit,Affiliated Hospital of Hangzhou Normal University from March 2011 to August 2012.Taking 28 days-survival as dividing line,the patients were divided into groups survival（n=38）,death（n=19）.The difference of fluid balance was analyzed.The patients were divided,according to D-value of EVLWI（ΔEVLWI） 〈-3 ml /kg and IAP（ΔIAP） 〈-1 mm Hg（1 mm Hg=0.133 kPa）,into groups effect,non-effect.The difference of death rate was analyzed in 2 groups.Results There was no significant difference in fluid balance between groups survival,death within 6h of admittance to ICU（P〈0.05）,but there was in total fluid balance on days 1,2,3 of ICU admittance（P〈0.0001）.The ΔEVLWI was（-3.91 ± 1.21） ml /kg in survival group,（-2.03 ± 1.92） ml /kg in death group,and the ΔIAP was-1.0（-2.0 ～ 1.0） mm Hg in survival group,1.0（0 ～ 2.0） mm Hg in death group,the difference was significant（t=4.53,3.70,P〈0.05）.ΔEVLWI,ΔIAP were positively correlated with total fluid balance within 3 d（r=0.43,0.40,P〈0.05）.The mortality was lower in effect group than in non-effect group（22% vs 55%,4% vs 53%）.Conclusion Survival patients have negative fluid balance within 3 d,while death patients does not have,suggesting that negative fluid balance can improve patients＇ prognoses.ΔEVLWI reduced to3 ml /kg or ΔIAP to 1mm Hg suggests good prognosis.

关 键 词：休克 感染 补液疗法 液体平衡 腹内压 血管外肺水指数 

分 类 号：R631.4[医药卫生—外科学]