脉搏指示连续心输出量监测在感染性休克患者早期液体复苏中的临床价值  

The value of capacity indicators to patients with septic shock in the fluid resuscitation

作　　者：唐宇涛[1] 俞宁[1] 

机构地区：[1]广西壮族自治区人民医院急诊科,南宁530021

出　　处：《检验医学与临床》2015年第11期1508-1510,共3页Laboratory Medicine and Clinic

基　　金：广西壮族自治区卫生厅科研课题项目(Z2013317)

摘　　要：目的探讨根据脉搏指示连续心输出量(PICCO)监测中的容量指标对感染性休克患者的早期液体复苏,以及治疗效果和预后的影响。方法将该院急诊科重症监护病房收治的80例感染性休克患者随机分为根据中心静脉压(CVP)指导液体复苏治疗的对照组,和依据血管外肺水指数(EVWL)和全心舒张末期容积(GEDV)指导液体复苏治疗的实验组,每组各40例,2组患者经液体复苏治疗后的疗效与预后进行对比分析。结果实验组患者乳酸水平明显低于对照组,中心静脉血氧饱和度、氧合指数、尿量均明显高于对照组,差异均有统计学意义(P<0.05);实验组患者ICU时间、机械通气时间、使用血管活性药物时间均明显少于对照组,差异均有统计学意义(P<0.05);治疗后1h与6h,2组患者EVLWI、GEDVI、平均动脉压(MAP)、心率(HR)、CVP等指标比较,差异无统计学意义(P>0.05)。结论依据EVWL和GEDV指导感染性休克患者早期液体复苏治疗,能够改善患者的预后、降低病死率,具有临床意义。Objective To investigate the impact of capacity indicators on the treatment about the pulse index based on continuous cardiac output monitoring to septic shock. Methods 80 cases of septic shock patients in our hos- pital were randomly divided into control group according to central venous pressure to guide fluid resuscitation, and experimental group based on EVWL （extravascular lung water index） and GEDV （global end-diastolic volume） to guide fluid resuscitation therapy, each group of 40 people, and then efficacy and prognosis of patients after treatment by fluid were analysised in control group and experimental groupResults The lactate levels of experimental group was significantly lower than those in control group, central venous oxygen saturation, oxygenation index, urine were significantly higher than those in control group, the difference was statistically significant （P〈0.05）; Stay time of experimental group patients in ICU,mechanical ventilation time of experimental group patients, drug use frequency of vasoactive were significantly shorter than those in control group, the differences were statistically significant （P〈 0. 05） ; After 1 hour and 6 hours of treatment, the EVLWI, GEDVI, MAP, HR, CVP and other indicators in two groups was not statistically significant （P〉0.05）. Conclusion EVWL and GEDV guidance septic shock patients with early fluid resuscitation can improve the success rate of rehydration therapy significantly, and improve the prog nosis of patients, reduce mortality, which has important clinical reference significance.

关 键 词：感染性休克 血管外肺水指数 液体复苏 

分 类 号：R605.971[医药卫生—急诊医学]