超声测量下腔静脉变异度在颅脑术后合并急性呼吸窘迫综合征患者液体管理中的临床应用分析  

Clinical Application of Ultrasonography Measurement of Inferior Vena Cava Variability in Fluid Management of Patients with Acute Respiratory Distress Syndrome after Craniocerebral Operation

作　　者：叶先钦 许伟珍 莫建伟[1] 黄宏[1] 刘滨[1] 

机构地区：[1]广东省农垦中心医院,广东湛江524000

出　　处：《中国医学创新》2017年第29期41-44,共4页Medical Innovation of China

基　　金：湛江市科技计划项目(2016B01172)

摘　　要：目的:探讨超声测量下腔静脉变异度在颅脑术后合并急性呼吸窘迫综合征患者液体管理中的临床应用价值。方法:选取2016年4月-2017年3月在ICU住院的颅脑术后合并急性呼吸窘迫综合征的患者60例,将其随机分为观察组和对照组,各30例。观察组通过超声测量下腔静脉变异度指导液体管理,对照组通过监测中心静脉压指导液体管理。结果:观察组机械通气时间、住ICU时间及血管活性药物应用时间均明显短于对照组(P<0.05);观察组MODS发生率、死亡率分别为6.67%、36.67%,均明显低于对照组的23.33%、63.33%(P<0.05);治疗7 d后,观察组Pa O2/Fi O2明显高于对照组(P<0.05),而BNP水平、乳酸水平、呼吸频率均明显低于对照组(P<0.05);两组平均动脉压比较,差异无统计学意义(P>0.05);两组治疗第7天的各项指标与治疗前比较,差异均有统计学意义(P<0.05)。结论:超声测量下腔静脉变异度指导颅脑术后合并急性呼吸窘迫综合征患者液体管理可较准确判断患者的容量状态,明显改善患者的血流动力学指标,具有较高的临床应用价值。Objective：To evaluate the clinical value of ultrasonography measurement of inferior vena cava variability in fluid management of patients with acute respiratory distress syndrome after craniocerebral operation.Method：60 patients with acute respiratory distress syndrome after craniocerebral operation who were hospitalized in ICU from April 2016 to March 2017 were selected,they were randomly divided into the observation group and the control group,30 cases in each group.The observation group guided the fluid management by ultrasonography to measure the variability of the inferior vena cava.The control group guided the management of the fluid by monitoring the central venous pressure.Result：The time of mechanical ventilation,ICU time and vasoactive drug application time of the observation group were significantly shorter than those of the control group（P0.05）.The incidence of MODS and mortality of the observation group were 6.67% and 36.67%,they were significantly lower than 23.33% and 63.33% of the control group（P0.05）.The level of BNP,lactate and respiratory rate of the observation group were significantly lower than those of the control group（P0.05）.The mean arterial pressure between two groups were compared,the difference was not statistically significant（P0.05）.The indexes of treatment for 7 days were compared with those before treatment between two groups,the differences were statistically significant（ P0.05）.Conclusion：Ultrasound measurement of inferior vena cava variability to guide postoperative craniotomy with acute respiratory distress syndrome in patients with liquid management can accurately determine the patients＇ capacity status,significantly improve the patient＇s hemodynamic parameters,has a high clinical value.

关 键 词：超声测量下腔静脉变异度 颅脑术后合并急性呼吸窘迫综合征 液体治疗 

分 类 号：R651.1[医药卫生—外科学]