床边超声测定检查在危重症患者液体复苏的应用价值研究  

Application values of bedside ultrasound for fluid resuscitation in critically ill patients

作　　者：关远志 刘世专 张海晖 赖以玲 陈时松 GUAN Yuanzhi;LIU Shizhuan;ZHANG Haihui;LAI Yiling;CHEN Shisong(Department of Critical Care Medicine,Yangchun People’s Hospital in Guangdong,Yangchun529600,China;Department of Ultrasonography,Yangchun People’s Hospital in Guangdong,Yangchun529600,China)

机构地区：[1]广东省阳春市人民医院重症医学科,广东阳春529600 [2]广东省阳春市人民医院超声科,广东阳春529600

出　　处：《中国现代医生》2020年第7期94-96,100,共4页China Modern Doctor

基　　金：广东省阳江市科技计划项目(社发【2018】103)。

摘　　要：目的探讨床边超声检查对危重症患者液体复苏的指导意义。方法选取2018年3月~2019年7月收治的80例危重症患者作为研究对象,随机将研究对象分为床边超声组和对照组两组,每组各40例。床边超声组采用床边超声的测定参数值进行指导危重症患者的液体复苏治疗,对照组患者选择脉搏指示剂持续心排血量法(PICCO)对患者液体复苏治疗予以相关指导。两组患者均在早期进行液体复苏治疗,且均进行有效的综合治疗,最后比较患者液体复苏前后下腔静脉(IVC)内径、呼吸变异指数(RVI)、左室舒张末期容积(LVEDV);同时比较患者血管外肺水指数(EVLWI)、液体复苏前后的胸腔内血容量指数(ITBVI)、中心静脉压(CVP)以及两组患者液体复苏前后的心率、收缩压及舒张压、液体复苏治疗后各时间点即治疗后6 h、12 h、24 h的达标率。结果患者进行液体复苏后,其中床边超声组的各参数除RVI均升高,两组患者的心率、收缩压及舒张压在复苏前差异无统计学意义(P>0.05)。两组患者心率在复苏6 h后较复苏前明显下降,收缩压、舒张压较复苏前明显升高,差异有统计学意义(P<0.05)。复苏24 h,床边超声组心率明显优于对照组,差异有统计学意义(P<0.05)。结论对危重症患者进行液体复苏采用床边超声具有重要的指导作用。Objective To investigate application values of bedside ultrasound for fluid resuscitation in critically ill patients.Methods Eighty critically ill patients admitted in our hospital from March 2018 to July 2019 were selected as subjects.They were randomly divided into the bedside ultrasound group and the control group,with 40 in each group.In the bedside ultrasound group,fluid resuscitation was conducted based on ultrasound parameters from a bedside examination in critically ill patients.Those in the control group underwent fluid resuscitation based on the test results of a pulse indicator continuous cardiac output(PICCO)system.The early intervention of fluid resuscitation was performed in the two groups in condition of an effectively comprehensive treatment.The inner diameter of the inferior vena cava(IVC),respiratory variation index(RVI),left ventricular end-diastolic volume(LVEDV)before and after fluid resuscitation were compared.The extravascular lung water index(EVLWI),intrathoracic blood volume index(ITBVI),central venous pressure(CVP),heart rate(HR),systolic blood pressure(SBP)and diastolic blood pressure(DBP)before and after fluid resuscitation,and effective rates at 6,12 and 24 h after fluid resuscitation were compared between the two groups.Results All ultrasound parameters except for RVI were elevated in the bedside ultrasound group after fluid resuscitation.However,there were no significant differences in baseline HR,SBP and DBP between the two groups(P>0.05).The two groups presented decreased HR and increased SBP and DBP at 6 h after fluid resuscitation compared with the baseline data,with statistically significant differences(P<0.05).The bedside ultrasound group presented better HR than the control group at 24 h after resuscitation,with statistically significant differences(P<0.05).Conclusion Bedside ultrasound is of great significance for clinical guidance of fluid resuscitation in critically ill patients.

关 键 词：床边超声 危重症患者 液体复苏 PICCO 

分 类 号：R445.1[医药卫生—影像医学与核医学] R459.7[医药卫生—诊断学]