目标导向治疗联合重症超声在老年脓毒性休克的应用及其对血气指标的影响  

Application of goal-directed therapy combined with critical care ultrasound in elderly patients with septic shock and its influence on blood gas indexes

作　　者：马琴琴[1] 白大鹏[2] 杨晓静[1] 陈琛[1] 于英华[1] MA Qinqin;BAI Dapeng;YANG Xiaojing;CHEN Chen;YU Yinghua(Department of Critical Care,First Affiliated Hospital of Hebei North University,Zhangjiakou Hebei 075000,China;不详)

机构地区：[1]河北北方学院附属第一医院重症医学科,河北张家口075000 [2]天津市海河医院感染科,天津300350

出　　处：《中国急救复苏与灾害医学杂志》2022年第6期790-793,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：河北省医学科学研究重点课题计划(编号:20180825);2019张家口市科技计划项目(编号:1921130H)。

摘　　要：目的研究目标导向治疗联合重症超声在老年脓毒性休克的应用及其对血气指标的影响。方法采取前瞻性研究方法,以2019年1月—2020年12月就诊于河北北方学院附属第一医院重症医学科收治的年龄≥60岁的脓毒性休克患者60例作为研究对象,按照随机分组原则,将以上患者随机分为两组,每组患者30例,对照组液体复苏采用早期目标导向治疗,观察组采用目标导向性液体复苏治疗的同时,通过床旁超声进行检测。比较两组患者的APACHEΠ评分、SOFA评分、血流动力学指标、乳酸清除率、液体复苏量以及血气指标。结果经过治疗后,两组患者的APACHEΠ评分以及SOFA评分均显著改善,且观察组患者的APACHEΠ评分(t=5.305,P=0.000)以及SOFA评分(t=7.711,P=0.000)显著低于对照组;两组患者的CI、CVP、SVI、MAP、GEF、SVRI均显著上升,ITBVI、PVPI显著下降,且观察组患者的CI(t=5.415,P=0.000)、CVP(t=2.118,P=0.038)、SVI(t=5.988,P=0.000)、MAP(t=2.043,P=0.046)、GEF(t=10.168,P=0.000)、SVRI(t=5.481,P=0.000)显著高于对照组,ITBVI(t=2.561,P=0.013)、PVPI(t=5.133,P=0.000)显著低于对照组;治疗48 h内,观察组患者的乳酸清除率(t=6.186,P=0.000)显著高于对照组,液体复苏量(t=33.219,P=0.000)显著低于对照组;两组患者的PCO_(2)下降,pH、HCO_(3)^(-)显著升高,且观察组患者的pH(t=2.376,P=0.021)、HCO_(3)^(-)(t=5.205,P=0.000)显著高于对照组,PCO_(2)(t=9.291,P=0.000)显著低于对照组。结论老年脓毒性休克患者采用目标导向联合重症超声治疗,患者的血气指标恢复显著,治疗效果显著。Objective To study the clinical effects of goal-directed therapy combined with critical care ultrasound in elderly patients with septic shock and its effects on blood gas indexes.Methods In this prospective study,60 patients with septic shock aged over 60 years admitted to the Department of critical care medicine,the First Affiliated Hospital of Hebei North University from January 2019 to December 2020 were randomLy divided into two groups,30 cases in each group,The observation group was treated with target oriented fluid resuscitation,and detected by bedside ultrasound.APACHE II score,SOFA score,hemodynamic index,lactate clearance rate,fluid resuscitation volume and blood gas index were compared between the two groups.Results After treatment,the APACHE II score and SOFA score of the two groups were significantly improved,and the APACHE II score(t=5.305,P=0.000)and SOFA score(t=7.711,P=0.000)of the observation group were significantly lower than those of the control group;CI,CVP,SVI,MAP,GEF and SVRI of the two groups were significantly increased,ITBVI and PVPI were significantly decreased,and CI(t=5.415,P=0.000),CVP(t=2.118,P=0.038),SVI(t=5.988,P=0.000),MAP(t=2.043,P=0.046),GEF(t=10.168,P=0.000)and SVRI(t=5.481,P=0.000)of the observation group were significantly higher than those of the control group,ITBVI(t=2.561,P=0.013),PVPI(t=5.133,P=0.000)was significantly lower than that of the control group;Within 48 hours of treatment,the lactate clearance rate(t=6.186,P=0.000)of the observation group was significantly higher than that of the control group,and the fluid resuscitation volume(t=33.219,P=0.000)of the observation group was significantly lower than that of the control group;PCO_(2) decreased,pH and HCO_(3)^(-)increased significantly in the two groups,and pH(t=2.376,P=0.021),HCO_(3)^(-)(t=5.205,P=0.000)in the observation group were significantly higher than those in the control group,PCO_(2)(t=9.291,P=0.000)was significantly lower than that in the control group.Conclusion The elderly patients with septic shock

关 键 词：脓毒性休克 重症超声 目标导向 血气指标 

分 类 号：R459.7[医药卫生—急诊医学]