每搏量变异度在老年脓毒性休克患者中的应用  

Application of stroke volume variation in directing management of elderly septic shock patients

作　　者：王志[1] 汤卫兵[1] 刘野[1] 

机构地区：[1]长春市解放军第208医院重症医学科,130062

出　　处：《天津医药》2015年第2期203-206,共4页Tianjin Medical Journal

基　　金：吉林省科技发展计划项目重点科技攻关项目(20130206034SF)

摘　　要：目的探讨每搏量变异度(SVV)在老年脓毒性休克患者中的应用。方法将进行机械通气的老年脓毒性休克患者28例分为常规组13例和SVV指导组15例,常规组根据中心静脉压(CVP)指导容量复苏,SVV指导组根据SVV、心输出量(CO)指导容量复苏。观察2组患者复苏时间、复苏后血乳酸、氧合指数、CVP、平均动脉压(MAP)、N端尿钠肽前体(NT-pro B-NP)等变化,机械通气时间、24 h内左心功能不全发生率,28 d发生多器官功能障碍综合征(MODS)和死亡情况,记录SVV指导组复苏前后血流动力学参数SVV、CO、外周血管阻力(SVR)的变化。结果 SVV指导组复苏时间短于常规组(t=3.83),乳酸、NT-pro BNP较常规组下降(t分别为3.20和12.32,P<0.05),氧合指数较常规组升高(t=3.01,P<0.05)。2组左心功能不全、MODS及病死率差异无统计学意义(P分别为0.198、0.410和0.372)。SVV指导组复苏后CO、SVV较复苏前改善(P<0.05)。结论 SVV能更好地指导老年脓毒性休克患者的容量复苏。Objective To investigate the application of stroke volume variation（SVV） in directing management of elderly septicshock patients. Methods Patients who were diagnosed with elderly septic shock and supported with mechanical ventilation were in-cluded（n=28）. They were divided into control group（n=13） and SVV group（n=15）. Volume recovery was directed by CVP（central ve-nous pressure） in control group and by SVV and CO（cardiac output） in SVV guoup respectively. Blood lactate, oxidation index, CVP,MVP, NT-pro BNP, time of recovery, the length relying on mechanical ventilation and Vigileo parameters were compared after volumeresuscition. During the period of treatment, the incidence of acute left ventricle dysfunction within 24 hours, MODS within 28 days andmortality rates of all causes were compared between these two groups. Changes in SVV, cardiac output（CO） and systemic vascular re-sistance（SVR） in SVV group before and after resustation were recorded. Results Blood lactate acid and NT-pro BNP were significant-ly lower in SVV group compared with those in control group whereas oxidation index in SVV group were significantly higher than thatof control group. The time of resuscitation and the duration relying on mechanical ventilation were shorter in SVV group than those incontrol group. On the contrary, the incidence of acute left ventricle dysfunction,MODS and all mortality rates were not significantlydifferent between these two groups. There were significant differences between hemodynamic variables such as SVV, CO in SVV groupbefore and after resuscitation. Conclusion SVV may direct volume resuscitation more effective in elderly septic shock than CVP does.

关 键 词：休克 脓毒性 老年人 每搏量变异度 复苏术 

分 类 号：R441.9[医药卫生—诊断学]