无创超声心输出量检测在脓毒性休克中的应用价值  

Application value of non-invasive echocardiographic output detection in septic shock

作　　者：曹昆 海峰[1] 杨露[1] 杨涛[1] 卢世武 王全武 CAO Kun;HAI Feng;YANG Lu;YANG Tao;LU Shiwu;WANG Quanwu(Department of Critical Care Medicine,Dalian NO.3 People's Hospital,Dalian,Liaoning 116091,China)

机构地区：[1]大连市第三人民医院重症医学科,辽宁大连116091

出　　处：《现代医学与健康研究电子杂志》2021年第19期15-19,共5页Modern Medicine and Health Research

基　　金：大连市医学科学研究计划项目(编号:1711043)。

摘　　要：目的探讨对脓毒性休克患者应用无创超声心输出量检测技术救治的临床效果。方法选取2017年7月至2019年1月于大连市第三人民医院就诊的120例脓毒性休克患者为研究对象,采用随机数字表法将其分为对照组(60例)和观察组(60例),对照组患者入院2 h内行脉搏指示连续心排血量(PICCO)监测,观察组患者则采用无创超声心输出量检测仪(USCOM)进行监测,两组患者均采用6 h集束化复苏管理。比较两组患者入住ICU时及入住ICU后6、24、72 h的血乳酸水平及乳酸清除率;比较观察组患者入住ICU时及入住ICU后6、24、72 h的血流动力学参数水平;比较两组患者主要终点数据[72 h急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、机械通气时间、血管活性药物应用时间、入住ICU时间、多器官功能障碍综合征(MODS)的发生率及病死率]。结果与入住ICU时比,入住ICU后6、24、72 h两组患者乳酸值均呈显著下降趋势,且入住ICU后72 h观察组患者乳酸值显著低于对照组;入住ICU后6、24、72 h两组患者乳酸清除率均显著升高,且各时间点观察组乳酸清除率均显著高于对照组;与入住ICU时比,观察组患者入住ICU后6、24、72 h时外周血管阻力(SVR)均呈逐渐升高趋势,入住ICU后6、24、72 h时观察组患者每搏输出量变异度(SVV)水平均显著低于入住ICU时,且入住ICU后72 h SVV水平显著低于入住ICU后24 h;观察组患者72 h APACHEⅡ评分显著低于对照组,且机械通气时间、血管活性药物使用时间、入住ICU时间均显著短于对照组(均P<0.05),但两组患者MODS发生率和病死率比较,差异均无统计学差异(均P>0.05)。结论USCOM作为一种无创血流动力学检测技术,能够实时监测脓毒性休克患者血流动力学状态,缩短患者机械通气时间、血管活性药物使用时间及入住ICU时间,提高乳酸清除率,且不增加患者死亡的风险,临床救治效果更优。Objective To investigate the clinical effect of applying non-invasive echocardiographic output detection technology in the treatment of patients with septic shock.Methods A total of 120 patients with septic shock who were treated in the Dalian NO.3 People's Hospital from July 2017 to January 2019 were selected as the research objects,and they were divided into the control group(60 cases)and the observation group(60 cases)according to the random number table method.Patients in the control group were monitored for pulse-indicated continuous cardiac output(PICCO)within 2 hours of admission,and patients in the observation group were tested by the ultrasonic cardiac output monitor(USCOM),patients in both groups were managed by cluster resuscitation for 6 hours.Compared the blood lactic acid levels and lactic acid clearance rates of of patients in the two groups when they were admitted to the ICU and 6,24,and 72 hours after admitted to the ICU;compared the hemodynamic parameter levels of patients in the observation group when they were admitted to the ICU and 6,24,72 hours after admitted to the ICU;compared the primary endpoint datas of patients in the two groups[72 h Acute Physiological Function and Chronic Health Status Score SystemⅡ(APACHEⅡ)score,mechanical ventilation time,vasoactive drug application time,ICU stay time,multiple organ dysfunction syndrome(MODS)the incidence and fatality rate].Results Compared with the time when they were admitted to the ICU,the lactic acid values of patients in the two groups 6,24,and 72 h after admitted to the ICU showed a significant downward trend,and the lactic acid level of patients in the observation group was significantly lower than that in the control group 72 h after admitted to the ICU;the lactic acid clearance rate of patients in the two groups 24 and 72 h increased significantly,and the lactic acid clearance rate of the observation group was significantly higher than that of the control group at each time point;compared with when they were admitted to the ICU,the pe

关 键 词：脓毒性休克 无创超声心输出量检测 乳酸清除率 血流动力学 

分 类 号：R631[医药卫生—外科学]