液体负平衡对感染性休克合并急性肺损伤患者的影响  

Effect of Negative Fluid Balance on Patients with Septic Shock and Acute Lung Injury

作　　者：李红森 梁秋波[1] LI Hongsen;LIANG Qiubo(Xinyi People’s Hospital,Xinyi 525300,China;不详)

机构地区：[1]信宜市人民医院,广东信宜525300

出　　处：《中外医学研究》2021年第36期182-185,共4页CHINESE AND FOREIGN MEDICAL RESEARCH

基　　金：茂名市科技计划项目(2019095)。

摘　　要：目的:探讨液体负平衡对感染性休克合并急性肺损伤患者的影响。方法:选取2019年1月-2020年12月信宜市人民医院重症监护室收治的54例感染性休克合并急性肺损伤患者,简单随机分组法分为试验组(27例)和对照组(27例)。两组均接受液体复苏治疗,试验组采用负平衡的液体管理模式,对照组采用出入量平衡或适当正平衡的液体管理模式。观察两组液体复苏治疗前及治疗后6、12、24、48 h急性生理学及慢性健康状况Ⅱ(APACHEⅡ)量表评分,及液体复苏治疗前及治疗后1、3、5、7 d时心肺指标,记录两组机械通气时间与ICU入住时间,统计两组多器官功能障碍(MODS)发生率与28 d病死率。结果:治疗后12、24、48 h,试验组APACHEⅡ评分均明显低于对照组(P<0.05);治疗后3、5、7 d,试验组血管外肺脏水指数(EVLWI)均明显低于对照组,氧合指数(PaO_(2)/FiO_(2))均明显高于对照组,治疗后7 d,试验组MAP水平低于对照组(P<0.05)。试验组机械通气时间(5.69±1.22)d、ICU入住时间(7.16±2.38)d,均短于对照组的(7.81±1.94)、(11.90±3.51)d(P<0.05)。试验组MODS发生率为18.52%,28 d病死率为11.11%,均低于对照组的44.44%、33.33%(P<0.05)。结论:予以感染性休克合并急性肺损伤患者负平衡的液体管理模式,可以改善患者心肺功能,促进早期复苏,减少相关并发症与死亡。Objective:To explore the effect of negative fluid balance on patients with septic shock and acute lung injury.Method:A total of 54 patients with septic shock and acute lung injury admitted to the intensive care unit of Xinyi People’s Hospital from January 2019 to December 2020 were selected and divided into experimental group (27 cases) and control group (27 cases) by simple random grouping method.Both groups received fluid resuscitation therapy,the experimental group received negative balance fluid management mode,and the control group received inflow balance or appropriate positive balance fluid management mode.The scores of acute physiology and chronic health status Ⅱ (APACHE Ⅱ) scale before and 6,12,24,48 h after fluid resuscitation treatment were observed,and the cardiopulmonary indexes before and 1,3,5,7 d after fluid resuscitation treatment were recorded.The mechanical ventilation time and ICU stay time of the two groups were recorded.The incidence of multiple organ dysfunction (MODS) and 28 d mortality were analyzed.Result:At 12,24 and 48 h after treatment,APACHE Ⅱ score in the experimental group were significantly lower than those in the control group (P<0.05).On 3,5 and 7 d after treatment,the extra-vascular lung water index (EVLWI) of experimental group were significantly lower than those of control group,and the oxygenation index (PaO_(2)/FiO_(2)) of experimental group were significantly higer than those of control group.On 7 d after treatment,the MAP level of experimental group was lower than that of control group (P<0.05).The mechanical ventilation time was (5.69±1.22) d and ICU stay time was (7.16±2.38) d in experimental group,which were shorter than (7.81±1.94) and (11.90±3.51) d in control group (P<0.05).The incidence of MODS in experimental group was 18.52%,and the 28-day mortality was 11.11%,which were lower than 44.44% and 33.33% in control group (P<0.05).Conclusion:Patients with septic shock and acute lung injury adopt a negative balance fluid management model,which can improve th

关 键 词：感染性休克 急性肺损伤 液体负平衡 早期复苏 预后 

分 类 号：R459.7[医药卫生—急诊医学] R563[医药卫生—治疗学]