早期目标指导治疗达标后不同胸腔内血容量指数指导液体管理对脓毒性休克患者心肺功能的影响  

Influence of ITBVI-guided fluid management after satisfied EGDT on cardio-pulmonary function of patients with septic shock

作　　者：孟东亮[1] 孙雪东[1] 应利君[1] 

机构地区：[1]浙江省绍兴市人民医院重症医学科,浙江绍兴312000

出　　处：《中国现代医生》2017年第17期76-81,共6页China Modern Doctor

基　　金：浙江省绍兴市科技计划项目(2014B70066)

摘　　要：目的探讨脓毒性休克患者早期目标指导治疗(EGDT)达标后在脉搏指示连续心输出量监测技术(PiCCO)测定的胸腔内血容量指数(ITBVI)指导下采取不同液体管理方式对患者心肺功能的影响。方法选择2014年7月~2016年6月入住我院重症医学科,符合纳入标准的脓毒性休克患者65例,按EGDT方案复苏,同时在入科后6 h内开始PiCCO监测,达标后随机分为液体限制组和液体非限制组,并采集病例相关数据。动态检测并比较两组患者入科后不同时段液体出入量、胸腔内血容量指数(ITBVI)、心输出量指数(CI)、血管外肺水指数(EVLWI)、肺血管通透性指数(PVPI)、血清B型钠尿肽(BNP)等指标。记录并比较两组患者机械通气时间、住ICU时间等。结果入科后24 h、48 h、72 h、96 h、120 h,两组间液体入量、每日液体平衡量(入量-出量)、ITBVI、EVLWI、BNP比较差异有统计学意义(P<0.05),而CI、PVPI比较差异无统计学意义(P>0.05)。液体非限制组的EVLWI与ITBVI、EVLWI与BNP均成正相关(P<0.05)。液体限制组使用呼吸机时间、住ICU时间均少于液体非限制组(P<0.05)。结论利用略低于正常的ITBVI指导EGDT达标后限制性液体管理,可改善脓毒性休克患者心肺功能,减少肺水产生,缩短机械通气时间和住ICU时间。Objective To explore the influence of PiCCO-measured ITBVI-guided fluid management after satisfied EGDT on cardio-pulmonary function of patients with septic shock. Methods 65 patients with septic shock treated in our unit from July 2014 to June 2016 were selected. The patients were given EGDT and their PiCCO were monitored 6 hours after admission. When the result of EGDT was satisfied, the patients were randomly divided into fluid restriction group and fluid non-restriction group, and their data were collected. The intake and output of fluid, ITBVI, CI, EVLWI, PVPI, and serum BNP at different time were dynamically monitored and compared between two groups. The duration of mechanical ventilation and ICU stay were also recorded and compared. Results There were significant differences in intake and output of fluid, daily fluid balance（intake-output）, ITBVI, EVLWI, and BNP between two groups at 24 h, 48 h, 72 h, 96 h, and 120 h after admission （P〈0.05）, while there was no significant difference in CI and PVPI （P〉0.05）. In the fluid non-restriction group, the EVLWI had a positive correlation with ITBVI, and EVLWI showed a positive correlation with BNP（P〈0.05）. The duration of breathing machine application and ICU stay were significantly shorter in the fluid restriction group than in the fluid non-restriction group（P〈0.05）. Conclusion Application of ITBVI （slightly lower than normal） in guidance of restricted fluid management after satisfied EGDT can improve the cardio-pulmonary function of patients with septic shock, reduce edema in lungs, and shorten the duration of breathing machine application and ICU stay.

关 键 词：脓毒性休克 液体管理 脉搏指示连续心输出量监测技术 胸腔内血容量指数 B型钠尿肽 

分 类 号：R541.6[医药卫生—心血管疾病]