不同容量反应性的心脏手术后患者早期合理液体入量的阈值效应分析  

Analysis of threshold effect on early reasonable fluid intake in patients with different fluid responsiveness after cardiac surgery

作　　者：徐晓华 张玉侠 林颖 刘睿艳 郑吉莉 陈轶洪 王文硕[2] XU Xiaohua;ZHANG Yuxia;LIN Ying;LIU Ruiyan;ZHENG Jili;CHEN Yihong;WANG Wenshuo(Department of Nursing,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Cardiac Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院护理部,上海200032 [2]复旦大学附属中山医院心脏外科,上海200032

出　　处：《护士进修杂志》2023年第2期121-125,131,共6页Journal of Nurses Training

基　　金：复旦大学复星护理科研项目(编号:FNF201944)。

摘　　要：目的探讨不同容量反应性的心脏手术后患者术后早期液体入量与容量超负荷发生的关系并确定合理液体入量。方法于2020年10月—2021年11月在复旦大学附属中山医院选择519例心脏手术后患者(容量有反应组260例,容量无反应组259例),术后连续3 d记录患者的出入量,计算患者日均液体入量体质量比、日均液体累积比,同时判断患者是否出现容量超负荷。采用平滑曲线拟合和分段回归模型进行阈值效应分析,得出合理液体入量阈值。结果日均液体累积比和日均入量体重比分别适用于容量有反应组和无反应组的心脏术后患者容量超负荷预测;在容量有反应组,当日均液体累积比处于1.7%~2.5%时,该指标与容量超负荷呈线性增长关系(OR=9.6),而在以上范围之外,其与容量超负荷的关系无统计学意义(P>0.05);在容量无反应组,当日均入量体重比≥2.5%时,该指标与容量超负荷呈线性增长关系(OR=7.8),否则,其与容量超负荷的关系无统计学意义(P>0.05)。结论心脏术后早期应先对患者进行容量反应性判断以指导液体摄入。对于容量有反应的患者,应保证其液体累积百分比<1.7%,对于容量无反应的患者,应保证其液体入量体重比<2.5%,若液体累积或摄入量超过以上阈值,有必要尽快通过利尿、血滤、强心等措施,对抗容量超负荷带来的疾病恶化风险。Objective To explore the relationship between early fluid intake and fluid overload in patients with different fluid responsiveness during the early postoperative period for determining the reasonable fluid intake.Methods A total of 519 patients after cardiac surgery(260 with fluid responsiveness and 259 without fluid responsiveness)were selected form Zhongshan Hospital Affiliated to Fudan University from October 2020 to November 2021.The volume of fluid intake and output were recorded for 3 consecutive days after surgery to calculate the average daily fluid intake to weight ratio and the average daily fluid balance to weight ratio,fluid overload was also judged.Smoothed curve fitting and segmental regression model were used for threshold effect analysis to obtain reasonable fluid intake thresholds.Results The average daily fluid balance to weight ratio and the average daily fluid intake to weight ratio were applied to predict fluid overload for participants with or without fluid responsiveness,respectively.In the fluid-responsive group,when the average daily fluid balance to weigh ratio was in the range of 1.7%to 2.5%,its linear increasing relationship with volume overload was found(OR=9.6),while outside the above range,its relationship with fluid overload was not statistically significant(P>0.05);in the non-fluid-responsive group,when the average daily intake to weight ratio was≥2.5%,a linear increasing relationship with fluid overload was detected(OR=7.8),otherwise,no statistically significant was found(P>0.05).Conclusion Fluid responsiveness is a key indicator to guide fluid intake early after cardiac surgery.For patients with fluid responsiveness,daily fluid balance to weight ratio shall be kept<1.7%,and for patients without fluid responsiveness,daily intake to weight ratio shall be kept<2.5%.If the above thresholds are exceeded,it is necessary to take measures such as diuretic,hemofiltration,and cardiac enhancement as soon as possible to combat the risk of disease deterioration caused by volume overload.

关 键 词：容量反应性 心脏术后 合理液体入量 阈值效应 

分 类 号：R473.54[医药卫生—护理学]