液体复苏法对脓毒症休克患者下腔静脉直径、呼吸变异指数以及血乳酸的影响  

Effect of fluid resuscitation on inferior vena cava diameter,respiratory variability index,and blood lactate in patients with septic shock

作　　者：张锦丽 ZHANG Jinli(Intensive Care Unit,Hangzhou Hospital,Zhejiang Medical Health Group,Hangzhou 310021,China.)

机构地区：[1]浙江省医疗健康集团杭州医院重症监护室,浙江杭州310021

出　　处：《全科医学临床与教育》2020年第2期143-146,共4页Clinical Education of General Practice

摘　　要：目的研究液体复苏法对脓毒症休克患者下腔静脉直径、呼吸变异指数以及血乳酸的影响。方法选择64例脓毒症患者,分为接受机械通气组33例、自主呼吸组31例,均接受液体复苏治疗,采用超声测定液体复苏不同时间下腔静脉直径,计算呼吸变异指数,并比较不同时间血乳酸及乳酸清除率变化情况。结果液体复苏后,机械通气组和自主呼吸组下腔静脉直径最大值和最小值均明显增大,血乳酸水平明显降低,乳酸清除率明显升高,差异有统计学意义(F分别=17.06、14.98、19.03、15.71;16.52、15.80、17.52、15.72,P均<0.05),但机械通气组液体复苏前后呼吸变异指数无明显变化(F=4.13,P>0.05),而自主呼吸组呼吸变异指数明显降低(F=18.61,P<0.05)。液体复苏即刻、液体复苏30 min、60 min、180 min自主呼吸组呼吸变异指数较机械通气组明显上升(t分别=3.44、4.17、3.15、4.11,P均<0.05),液体复苏60 min、180 min自主呼吸组下腔静脉直径最大值和最小值较机械通气组明显降低(t分别=4.33、3.25、2.58、5.66,P均<0.05)。机械通气组液体复苏即刻、30 min、60 min、180 min的下腔静脉直径最大值、下腔静脉直径最小值与脓毒症休克时间均呈正相关(r分别=0.62、0.54、0.72、0.67;0.57、0.42、0.76、0.75,P均<0.05);而呼吸变异指数与脓毒症休克时间不具有明显相关性(r分别=-0.19、-0.11、-0.05、0.20,P均>0.05)。自主呼吸组液体复苏即刻、30 min、60 min、180 min的下腔静脉直径最大值与脓毒症休克时间均呈正相关(r分别=0.62、0.54、0.72、0.67,P均<0.05);液体复苏60 min和180 min下腔静脉直径最小值与脓毒症休克时间呈正相关,呼吸变异指数与脓毒症休克时间呈负相关(r分别=0.71、0.64、-0.64、-0.44,P均<0.05)。结论液体复苏治疗脓毒症休克能够增大患者下腔静脉直径、降低呼吸变异指数以及血乳酸含量,可以作为临床治疗脓毒症休克疾病的有效手段。并�Objective To explore the effect of fluid resuscitation on the diameter of inferior vena cava,respiratory variation index and blood lactate in patients with septic shock.Methods Totally 64 patients with sepsis were divided into mechanical ventilation group(33 cases)and spontaneous respiration group(31 cases).All patients were treated with liquid resuscitation.The diameter of inferior vena cava at different time was measured by ultrasound,respiratory variation index was calculated,and the changes of blood lactate and lactate clearance rate at different time were compared.Results After fluid resuscitation,the maximum and minimum values of the diameter of inferior vena cava in the mechanical ventilation group and the automatic respiration group were significantly increased,the level of blood lactate was significantly reduced,and the lactate clearance rate was significantly increased(F=17.06,14.98,19.03,15.71;16.52,15.80,17.52,15.72,P<0.05).There was no significant difference in the respiratory variability index before and after fluid resuscitation in the mechanical ventilation group(F =4.13,P>0.05),but the respiratory variation index before and after fluid resuscitation in the spontaneous respiration group was significantly different(F =18.61,P<0.05).The respiratory variation index in the spontaneous respiration group was significantly higher than that in the mechanical ventilation group at starting of fluid resuscitation,30 min,60 min,and 180 min after fluid resuscitation(t=3.44,4.17,3.15,4.11,P<0.05).The maximum and minimum diameters of inferior vena cava in the spontaneous respiration group were significantly lower than those in the mechanical ventilation group at 60 min and 180 min after fluid resuscitation(t=4.33,3.25,2.58,5.66,P<0.05).In the mechanical ventilation group,the maximum and minimum diameters of inferior vena cava were positively correlated with the septic shock time at starting of fluid resuscitation,30 min,60 min,and 180 min after fluid resuscitation(r= 0.62,0.54,0.72,0.67;0.57,0.42,0.76,0.75,P<0.0

关 键 词：液体复苏 下腔静脉直径 呼吸变异指数 脓毒症 血乳酸 

分 类 号：R459.7[医药卫生—急诊医学]