床旁超声指导重症脓毒症患者早期液体复苏的临床应用价值  

Clinical significance of early fluid resuscitation in patients with sepsis guided by bedside ultrasound

作　　者：要莉莉 贾丽静 段希洁 张丽 张婷婷 YAO Li-li;JIA Li-jing;DUAN Xi-jie(Department of ICU, People's Hospital of Cangzhou, Cangzhou Hebei 061000, China)

机构地区：[1]沧州市人民医院重症医学科

出　　处：《临床和实验医学杂志》2019年第12期1320-1323,共4页Journal of Clinical and Experimental Medicine

基　　金：河北省科技支撑计划项目(编号:172302021)

摘　　要：目的探讨脓毒症患者重症监护早期液体复苏治疗过程中选择床旁超声指导方式的先进性。方法采用前瞻性的研究方法,选取2017年10月至2018年10月在沧州市人民医院住院治疗的100例重症脓毒症患者作为研究对象,按照简单化随机分组法将患者平均分为观察组和对照组,每组各50例。观察组患者选择床旁超声指导液体复苏治疗,对照组患者选择脉搏指示剂持续心排血量法(PICCO)指导液体复苏治疗。比较两组患者液体复苏前后的血流动力学参数、液体复苏治疗后各时间点(治疗后6 h、24 h、72 h)的达标率、液体复苏达标后的最终液体复苏量与药物用量及终点事件发生情况。结果两组患者复苏治疗6 h后的平均静脉压(MVP)(79.1±9.8 vs.78.3±9.2) mm Hg、中心静脉压(CVP)(13.4±3.7 vs.11.2±5.3) mm Hg均明显高于复苏治疗前(P <0.05)(67.8±12.5 vs.68.5±13.4) mmHg、(8.6±3.3 vs.9.1±2.1) mm Hg,复苏治疗24 h后的MAP明显高于复苏治疗前(P <0.05);观察组患者复苏治疗6h后的CVP明显高于对照组(P <0.05)。观察组患者液体复苏治疗后各时间点的治疗达标率均明显高于对照组(P <0.05)。观察组患者最终液体复苏量(3 128.6±316.7) ml明显低于对照组(3 544.3±304.8) ml(P <0.05),两组患者血管活性药物用量差异无统计学意义(4.48±1.52 vs.4.37±1.47)μg(P> 0.05)。观察组患者最终需要持续肾脏替代治疗(CRRT)治疗率(14.0%)和3 d内肺水肿发生率(4.0%)明显低于对照组(60.0%、14.0%)(P <0.05)。结论床旁超声检测指导早期液体复苏,能够有效提高脓毒症患者的血流动力学指标,减少液体复苏用量以及持续肾脏替代治疗比率,具有较高的临床应用价值。Objective To explore the advancement in selection of bedside ultrasound guidance during the early liquid resuscitation of patients with sepsis in intensive care unit.Methods By using prospective study method,100 patients with severe sepsis admitted to the People’s Hospital of Zhangzhou City during October 2017 to October 2018 were selected as study subjects.All these patients were equally divided into observation group and control group according to simplified randomization method.Each group consisted of 50 patients.Patients in observation group were treated with bedside ultrasound-guided fluid resuscitation,and patients in control group were selected for pulse-indicator continuous cardiac output( PICCO) to guide fluid resuscitation.The hemodynamic parameters before and after fluid resuscitation in these two groups,the compliance rate at each time point after treatment for fluid resuscitation( 6 h,24 h,72 h after treatment),the final fluid resuscitation,dosage of drug and end point event were compared.Results Mean venous pressure( MVP)( 79.1±9.8 vs.78.3±9.2) mm Hg after 6 h resuscitation and central venous pressure( CVP)( 13.4±3.7 vs 11.2±5.3) mm Hg in both groups were significantly higher than those before resuscitation( 67.8±12.5 vs.68.5±13.4) mmH g,( 8.6±3.3 vs.9.1±2.1) mm Hg before resuscitation( P < 0.05),MAP after 24 h of resuscitation was significantly higher than that before resuscitation( P < 0.05) in observation group.The CVP after 6 hours was significantly higher than that of control group( P < 0.05).The treatment compliance rate of observation group at each time point after fluid resuscitation was significantly higher than that of control group( P < 0.05).The final fluid resuscitation( 3 128.6±316.7) ml was significantly lower in observation group than that( 3 544.3±304.8) ml) of control group( P < 0.05).There was no significant difference in the amount of vasoactive substance between these two groups( 4.48±1.52 vs.4.37±1.47)μg( P > 0.05) The treatment rate( 14.0%) in final treatment gr

关 键 词：脓毒症 早期液体复苏 床旁超声 

分 类 号：R459.7[医药卫生—急诊医学]