老年脓毒性休克患者急性胃肠道损伤超声表现及相关性研究  

Ultrasound manifestations on aute gastrointestinal injury in elderly patients with septic shock and related studies

作　　者：潘春熹[1] 陈万[1] 吕立文[1] 唐宇涛[1] 朱瑞凯[1] 朱良峰[1] PAN Chunxi;CHEN Wan;LV Liwen;TANG Yutao;ZHU Ruikai;ZHU Liangfeng(Department of Emergency,the Guangxi Zhuang Autonomous Region Peoples Hospital,Nanning,530021,China)

机构地区：[1]广西壮族自治区人民医院急诊科,南宁530021

出　　处：《临床急诊杂志》2020年第4期261-266,共6页Journal of Clinical Emergency

基　　金：广西科技攻关计划项目(No:桂科攻15277007);广西医疗卫生适宜技术研究及开发项目(No:S201552)。

摘　　要：目的:探讨老年脓毒性休克患者的胃肠道超声情况及与急性胃肠损伤(AGI)的关系。方法:选取2018-01-2019-06期间我院急诊重症医学科收治的62例老年脓毒性休克患者,均给予脓毒性休克集束治疗,收集患者基线资料,动态评估2组患者AGI情况及胃肠道超声变化,根据是否出现AGI分为AGI组及非AGI组,比较2组患者治疗前后急性生理与慢性健康评分Ⅱ(APACHEⅡ)、全身性感染相关性器官功能衰竭评分(SOFA)、血肌酐、腹腔内压及胃肠道B超等指标,Logistics多因素回归分析发生AGI危险因素。结果:老年脓毒性休克患者AGI发病率为64.52%;AGI组SOFA评分、腹腔内压(IAP)显著高于非AGI组患者(P<0.05);平均动脉压(MAP)、胃动力指数(MI)、肠系膜上动脉舒张末期流速(VPd)显著低于非AGI组患者(P<0.05);Logistics回归分析提示MI、IAP是老年脓毒性休克患者发生AGI的独立危险因素。结论:老年脓毒性休克患者AGI发生率较高,床边超声有助于AGI诊疗,较高的复苏血压有助减少AGI的发生。Objective:To explore the ultrasound manifestations on aute gastrointestinal injury in elderly patients with septic shock and related studies.Method:A total of 62 elderly patients with septic shock were enrolled from January 2018 to June 2019 in emergency department at our hospital.Subjects’general information and AGI characteristics were assessed.Everyone were collect in the changes of the acute physiology and chronic health status score(APACHEⅡ),sepsis related organ failure assessment(SOFA),AGI rating,creatinine,intra-abdominal pressure(IAP),Gastrointestinal ultrasound and blood flow velocity of uperior mesenteric arter before and after treatment.AGI group and non-AGI group were divided according to the presence and absence of acute gastrointestinal injury.Multivariate logistic regression analysis was used to analyze the independent risk factors for AGI in these patients.Result:Compared with the non-AGI group,The AGI group level of APACHEⅡ,SOFA,blood lactate,IAP and the incidence of AGI had significantly decrease(P<0.05).Consequently,AGI group had significant increase in motility index(MI),VPd(P<0.05).Logistic regression analysis showed that MI and IAP were independent risk factors for AGI in elderly patients with septic shock.Conclusion:Elderly patients with septic shock have a higher incidence of AGI,Ultrasound is helpful in AGI diagnosis and treatment,high target blood pressure in sepsis shock cluster therapy can improve renal perfusion and reduce the risk of AGI in elderly patients.

关 键 词：老年 脓毒症 急性胃肠道损伤 超声表现 

分 类 号：R592[医药卫生—老年医学] R631.2[医药卫生—内科学]