不同血流动力学参数联合指导脓毒性休克合并急性呼吸窘迫综合征目标导向性补液治疗对临床预后的影响  

Influence of different hemodynamic parameters combined to guide septic shock complicated with ARDS goal-directed fluid therapy on clinical prognosis

作　　者：韦茵[1] 熊敏君 罗建宇[1] WEI Yin;XONG Min-jun;LOU Jian-yu(Department of Critical Care Medicine,Liuzhou People's Hospital,Guangxi Liuzhou 545006,China)

机构地区：[1]柳州市人民医院重症医学科,广西柳州545006

出　　处：《内科急危重症杂志》2022年第1期50-53,共4页Journal of Critical Care In Internal Medicine

摘　　要：目的:探讨胸腔内血容量指数(ITBVI)、血管外肺水指数(EVLWI)、心指数(CI)等血流参数联合监测对老年脓毒性休克伴急性呼吸窘迫综合征(ARDS)患者进行目标导向性补液治疗的应用价值。方法:回顾性收集2017年4月-2018年7月柳州市人民医院收治的62例老年脓毒性休克伴ARDS患者临床资料,其中31例以中心静脉压(CVP)监测为指导行目标导向性补液治疗,为对照组;另31例行持续心输出量(PICCO)监测,以ITBVI、EVLWI、CI为指导进行补液治疗,为研究组,分析比较2组患者相关指标变化及疗效。结果:研究组患者补液治疗6、24 h达标率显著高于对照组(77.42%vs 45.16%;93.55%vs 70.95%,P均<0.05),平均动脉压(MAP)、CVP、复苏液体量、每小时尿量显著高于对照组(P均<0.05);治疗72 h,研究组序贯器官衰竭评分(SOFA)、急性生理与慢性健康状况评估(APACHEⅡ)评分及去甲肾上腺素剂量、血清乳酸、呼吸参数(呼气末正压、呼吸频率、顺应性、氧合指数)显著优于治疗24 h,且显著优于对照组(P均<0.05);研究组治疗72 h血肌酐显著低于对照组(P<0.05);研究组机械通气率及28 d病死率显著低于对照组(48.39%vs 74.19%;12.90%vs 35.48%,P均<0.05),患者平均机械通气、住ICU时间显著短于对照组(P均<0.05)。结论:ITBVI、EVLWI、CI联合监测指导老年脓毒性休克伴ARDS患者目标导向性补液治疗,有助于改善预后,降低患者病死率。Objective: To investigate the applied value of combined monitoring of intrathoracic blood volume index(ITBVI), extravascular lung water index(EVLWI) and cardiac index(CI) and other blood flow parameters for goal-directed rehydration therapy in elderly patients with septic shock with acute respiratory distress syndrome(ARDS). Methods: The clinical data of 62 elderly patients with septic shock with ARDS admitted to our hospital from April 2017 to July 2018 were collected for retrospective analysis. The control group(n=31) was treated with goal-directed rehydration therapy guided by central venous pressure(CVP) monitoring. In the study group(n=31), pulse indicator continuous cardiac output(PICCO) was monitored, and rehydration therapy was guided by ITBVI, EVLWI and CI.Results: The reaching standard rate of rehydration therapy in the study group was 77.42% and 93.55% at 6 h and 24 h respectively, significantly higher than 45.16% and 70.98% in the control group(both P<0.05). MAP, CVP, resuscitated fluid volume and hourly urine output in the study group were significantly higher than those in the control group(all P<0.05). At 72 h of treatment, the SOFA and APACHE Ⅱ scores, norepinephrine dose, serum lactate and respiratory parameters(positive end-expiratory pressure, respiratory rate, compliance and oxygenation index) were significantly better than those in the control group(P<0.05);the blood creatinine at 72 h was significantly lower in the study group than in the control group(P<0.05);the mechanical ventilation rate was 48.39% and the 28-d mortality rate was 12.90% in the study group, which were significantly lower than 74.19% and 35.48% respectively in the control group(P<0.05);and the average mechanical ventilation time and ICU stay were significantly shorter than those in the control group(both P<0.05). Conclusion: The combined monitoring of ITBVI, EVLWI and CI to guide goal-directed rehydration therapy in elderly patients with septic shock with ARDS can help improve prognosis and reduce mortality of patients.

关 键 词：脓毒性休克 急性呼吸窘迫综合征 目标导向性补液治疗 机械通气 

分 类 号：R515.3[医药卫生—内科学]