超声指导下液体管理对急性呼吸窘迫综合征患者预后影响的研究  

Study on the effect of ultrasound guided liquid management on the prognosis of patients with acute respiratory distress syndrome

作　　者：梁伟军[1] 谭洪毅 谢和宾[1] 杨勇[2] 杨红忠[1] 曾晓媛[1] LIANG Wei-jun;TAN Hong-yi;XIE He-bin;YANG Yong;YANG Hong-zhong;ZENG Xiao-yuan(Department of RICU,Changsha Central Hospital,Changsha,Hunan 410004,China)

机构地区：[1]长沙市中心医院RICU,湖南长沙410004 [2]长沙市中心医院中心ICU,湖南长沙410004

出　　处：《临床肺科杂志》2019年第4期680-684,共5页Journal of Clinical Pulmonary Medicine

基　　金：湖南省医药卫生计划项目(B2017205)

摘　　要：目的探讨超声指导下液体管理能否改善急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者的预后。方法选择我院RICU和中心ICU近两年中重度ARDS机械通气患者60例病人,按是否应用超声指导液体管理分为两组,即传统液体管理组(传统组)和超声指导下液体管理组(超声组),分别收集两组病人7天内液体平衡、氧合指数、序贯器官衰竭(sequential organ failure assessment, SOFA)评分、有创机械通气时长、住ICU天数、28天生存率,对比两组之间的各项指标的差异。结果对比传统组,第1天、第3天、第5天、第7天,超声组累积液体正平衡均更低(P<0.001);超声组患者第1、3、5、7天氧合指数均高于传统组(85±8.8 vs 81±8.6,118±10.0 vs 112±9.6,155±14.0 vs 146±12.9,185±15.6 vs 171±18.0,P<0.05),超声组在第1、3天SOFA评分与传统组无显著差别(10.2±3.1 vs 10.5±2.8,9.5±3.0 vs 9.8±2.6,P>0.05),而在第5、7天明显低于传统组(7.2±2.3 vs 8.5±2.5,4.3±1.5 vs 5.5±2.0,P<0.05);对比传统组,超声组有创机械通气时间更短(8.8±2.0 vs 10.6±2.8,P<0.05),住ICU天数更短(10.5±2.1 vs 13.0±3.5,P<0.05),但28天死亡率无显著差别(33.3%vs 26.7%,P>0.05)。结论相对于传统方法,超声指导方法更有利于ARDS患者限制性液体管理的实施;超声指导液体管理可以更好地改善氧合和器官功能,缩短有创机械通气时间和减少住ICU天数,但不能降低28天死亡率。Objective To explore whether liquid management under ultrasound guidance can improve the prognosis of patients with acute respiratory distress syndrome.Methods 60 patients with mild-severe ARDS mechanical ventilation were selected from RICU and CENTRAL-ICU in our hospital during the past two years.According to the application of ultrasonic guided liquid management,all patients were divided into two groups,the traditional liquid management group(the traditional group)and the ultrasound guided liquid management group(the ultrasonic group).Their liquid balance volume,oxygenation index,SOFA score,invasive mechanical ventricular duration,ICU stay and 28-day mortality were collected and compared between the two groups.Results Compared with the traditional group,the cumulative liquid equilibrium of the ultrasonic group was lower on Day 1,3,5 and 7(P<0.001).The oxygenation indexes were higher in the ultrasonic group than in the traditional group(85±8.8 vs 81±8.6,118±10.0 vs 112±9.6,155±14.0 vs 146±12.9,185±15.6 vs 171±18.0,P<0.05).There was no significant difference in SOFA scores on Day 1 and 3 between the two groups(10.2±3.1 vs 10.5±2.8,9.5±3.0 vs 9.8±2.6,P>0.05),whereas in the 5th and 7th days,it was significantly lower in the ultrasonic group than in the traditional group(7.2±2.3 vs 8.5±2.5,4.3±1.5 vs 5.5±2.0,P<0.05).Compared with the traditional group,the ultrasonic group had shorter mechanical ventilation time(8.8±2.0 vs 10.6±2.8,P<0.05),shorter ICU stay(10.5±2.1 vs 13.0±3.5,P<0.05),but the 28-day mortality showed no significant difference(33.3% vs 26.7%,P>0.05).Conclusion The ultrasonic guidance method is more beneficial to the implementation of restricted liquid management of ARDS patients,and it can better improve oxygenation and organ function,shorten the duration of invasive mechanical ventilation and reduce ICU stay,but it can not reduce the 28-day mortality.

关 键 词：急性呼吸窘迫综合症 液体管理 超声 血管外肺水 

分 类 号：R563.8[医药卫生—呼吸系统]