无创超声心排血量监测技术联合被动抬腿试验在老年脓毒症患者液体复苏中的应用  

Application of noninvasive ultrasound cardiac output monitoring(USCOM)in fluid resuscitation for elderly patients with sepsis

作　　者：孙乾辉[1] 曹加明[1] 孙婷[1] 张健[1] 曹宇亮 SUN Qianhui;CAO Jiaming;SUN Tting(Department of Critical Care Medicine,72th Group Military Hospital of PLA,Huzhou 313000,China)

机构地区：[1]中国人民解放军陆军第72集团军医院(原解放军98医院)重症医学科,湖州313000

出　　处：《浙江医学》2020年第9期935-938,共4页Zhejiang Medical Journal

基　　金：2015年度南京军区医学科技创新课题(15MS007)。

摘　　要：目的探讨无创超声心排血量监测(USCOM)技术联合被动抬腿试验指导老年脓毒症患者液体复苏的应用价值。方法选择ICU需要液体复苏的老年脓毒症患者56例。信封法随机分为常规组30例和USCOM组26例。常规组按EGDT方案复苏。USCOM组监测被动抬腿试验后每搏量(SV)变化,以△SV≥10%定义为有容量反应性并积极液体复苏。若△SV<10%,需限制补液或减慢补液速度。同时根据体循环外周血管阻力及心脏指数调整去甲肾上腺素、多巴酚丁胺等血管活性药物剂量。观察治疗前及治疗后6h血乳酸、前脑钠肽(pro-BNP)、氧合指数、心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)等指标和48h液体平衡情况、48h血管活性药物用量、平均机械通气时间、28d病死率等。结果与治疗前比较,两组患者治疗后6h HR变化均无统计学意义(均P>0.05),血乳酸、氧合指数明显下降(均P<0.05),pro-BNP、MAP、CVP等均明显升高(均P<0.05)。两组患者治疗后6h乳酸、HR、MAP、CVP等比较差异均无统计学意义(均P>0.05),常规组较USCOM组pro-BNP更高(P<0.05),氧合指数下降更明显(P<0.05)。USCOM组较常规组48h液体平衡明显减少(P<0.01),48h去甲肾上腺素用量明显增多(P<0.01);平均机械通气时间,USCOM组较常规组明显减少(P<0.01);两组患者28d病死率比较差异无统计学意义(P>0.05)。结论USCOM联合被动抬腿试验能有效指导液体复苏及血管活性药物应用,避免盲目液体复苏,减轻患者疾病严重程度,缩短机械通气时间,USCOM作为一项无创、便携的心输出量监测工具,可用于临床指导老年脓毒症患者液体治疗。Objective To explore the value of noninvasive ultrasound cardiac output monitoring(USCOM)combined with passive leg raising test in guiding fluid resuscitation in elderly patients with sepsis.Methods 56 elderly patients with sepsis admitted to our hospital for fluid resuscitation were enrolled.Patients were randomly assigned into routine group(n=30)and USCOMgroup(n=26).Patients in routine group were resuscitated according to the EGDT plan.In USCOM group the changes of stroke volume(SV)after passive leg raising test were monitored,△SV>10%was defined as volume-responsive for active fluid resuscitation.If△SV<10%,it is necessary to limit fluid replacement or slow down the speed of fluid replacement.At the same time,the dosage of vasoactive drugs such as norepinephrine and dobutamine should be adjusted according to systemic peripheral vascular resistance and cardiac index.The blood lactic acid,pro-BNP,oxygenation index,HR,MAP,CVP,48h fluid balance,48h vasoactive drug dosage,average mechanical ventilation time and 28d mortality were observed.Results There was no significant change in heart rate(P>0.05),but blood lactate and oxygenation index were declined(P<0.05),pro-BNP,MAP,and CVP were raised after 6 h treatment(P<0.05).There was no significant difference in lactate,HR,MAP and CVP between the two groups after 6 h treatment(P>0.05).Pro-BNP in the routine group was higher than that in USCOM group[(3469±1035)ng/ml vs.(2586±612)ng/ml,P<0.05].The oxygenation index in the routine group decreased more significantly than that in the USCOM group[(115.3±27.5)mmHg vs.(135.6±30.6)mmHg,P<0.05].The 48h fluid balance in USCOM group decreased[(2812±652)ml vs.(3446±844)ml]and the 48h norepinephrine dosage increased[(56.5±8.3)mg vs.(50.2±6.4)]significantly compared with the routine group(P<0.01);the average mechanical ventilation time in USCOM group was significantly reduced[(6.2±1.4)d vs.(8.1±2.6)d,P<0.01].There was no significant difference in 28d mortality between the two groups(P>0.05).Conclusion USCOMcan effectively

关 键 词：无创超声心排血量监测 被动抬腿试验 容量反应性 老年 脓毒症 

分 类 号：R459.7[医药卫生—急诊医学]