应用无创心排量监测指导老年脓毒症休克病人早期液体复苏的临床研究  

Clinical research on applying non-invasive cardiac output mornitoring to direct early fluid resuscitation in elderly patients with sepsis shock

作　　者：陈侃侃[1] 宋熔[1] 牛芳[1] CHEN Kan-kan;SONG Rong;NIU Fang(ICU, the Fifth Hospital of Chinese PLA, Yinchuan 750001, China)

机构地区：[1]中国人民解放军第五医院重症医学科,宁夏回族自治区银川市750001

出　　处：《实用老年医学》2018年第4期361-364,共4页Practical Geriatrics

摘　　要：目的探讨无创心排量监测(NICOM)在老年脓毒症休克病人早期液体复苏治疗过程中的应用价值。方法选取老年脓毒症休克病人80例,随机分为常规组(40例)及NICOM组(40例)。2组均按照脓毒症休克指南给予相应治疗,NICOM组同时行NICOM监测血流动力学变化,指导补液量及调整血管活性药物剂量。结果治疗开始后6 h,NICOM组病人心率(HR)、中心静脉血氧饱和度(Scv O2)的改善情况明显好于常规组;治疗开始后24 h NICOM组病人中心静脉压(CVP)、Scv O2、氧合指数(Pa O2/Fi O2)明显高于常规组,HR、血乳酸(Lac)、脑钠肽(BNP)、丙氨酸氨基转移酶(ALT)、肌酐(Cr)较常规组明显下降,2组比较差异有统计学意义(P<0.05)。NICOM组机械通气、血管活性药物的使用和入住ICU的时间均明显少于常规组,液体复苏过程中的并发症(急性肺水肿、脑水肿及心力衰竭)发生率亦明显低于常规组,差异有统计学意义(P<0.05);2组28 d病死率差异无统计学意义(P>0.05)。结论老年脓毒症休克病人在NICOM监测下可达到早期液体复苏组织灌注目标,同时避免盲目补液,减少相关并发症,尽早脱机,缩短了住ICU时间,改善预后。Objective To discuss the application value of non-invasive cardiac output mornitoring（ NICOM） in the early fluid resuscitation treatment in elderly patients with sepsis shock. Methods Eighty elderly patients with sepsis shock were selected and randomly divided into routine treatment group（ 40 cases） and NICOM group（ 40 cases）. The two groups were given routine treatment for sapsis chock,and NICOM group conducted NICOM to direct fluid replacement volume and adjust dosages of vasoactive drugs additionally. Results The heart rate（ HR） and the level of blood lactic acid（ Lac） were improved more significantly in NICOM group than those in routine treatment group 6 h after the treatment.The central venous pressure（ CVP）,central venous oxygen saturation（ ScvO2）,oxygenation index（ PaO2/FiO2） were more significantly increased and the levels of HR,Lac,brain natriuretic peptide（ BNP）,alanine aminotransferase（ ALT） were more significantly decreased in NICOM group than those in routine treatment group 12 h after the treatment（ P〈0. 05）.The mechanical ventilation time,vasoactive agent using time and length of stay in ICU in NICOM group were significantly shorter and the incidence rate of complications（ such as acute pulmonary edema,encephaledema,heart failure） was significantly lower in NICOM group than that in routine treatment group（ P〈0. 05）. There was no difference in 28 d mortality between the two groups（ P〉0. 05）. Conclusions Elderly patients with sepsis shock can achieve early infusion target in fluid resuscitation by NICOM monitoring,and avoid blind fluid replacement,decrease the related complications,get away from the machine as soon as possible,shorten the length of stay in ICU.

关 键 词：无创心排量监测 老年人 脓毒症休克 液体复苏 

分 类 号：R589.9[医药卫生—内分泌]