无创心排血量监测联合EGDT指导脓毒性休克患者液体复苏的临床研究  

Clinical study of non-invasive cardiac output monitoring combined with early goal-directed therapy on fluid resuscitation in septic shock patients

作　　者：钱何布 郁莉莉 姚峰[1] 刘军[2] Qian Hebu;Yu Lili;Yao Feng;Liu Jun(Department of Critical Care Medicine,Suzhou Ninth Hospital Affiliated to Soochow University,Suzhou 215200,Jiangsu,China;Department of Critical Care Medicine,the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou 215001,Jiangsu,China)

机构地区：[1]苏州大学附属苏州九院重症医学科,江苏苏州215200 [2]南京医科大学附属苏州医院重症医学科,江苏苏州215001

出　　处：《中国中西医结合急救杂志》2023年第3期292-296,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：江苏省社会发展面上项目(BE2021660)。

摘　　要：目的评价无创心排血量监测(NICOM)技术联合早期目标导向治疗(EGDT)指导脓毒性休克患者液体复苏的临床价值。方法选择2019年6月至2021年6月入住苏州大学附属苏州九院重症医学科的80例脓毒性休克患者作为研究对象。按随机数字表法将患者分为EGDT组和NICOM组,每组40例。EGDT组采取EGDT液体复苏,NICOM组在EGDT基础上联合应用NICOM技术引导被动抬腿试验(PLR)指导液体复苏。比较两组治疗前和治疗后6 h心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、尿量、中心静脉血氧饱和度(ScvO_(2))、血乳酸(Lac),以及治疗后6、24及48 h复苏液体量、氧合指数(PaO_(2)/FiO_(2))、序贯器官衰竭评分(SOFA)评分和机械通气时间、重症监护病房(ICU)住院时间、28 d病死率的差异。结果两组治疗后HR、MAP、CVP、尿量、ScvO_(2)和Lac均较治疗前明显改善(均P<0.05);治疗后6 h EGDT组CVP明显高于NICOM组〔mmHg(1 mmHg≈0.133 kPa):8.35±1.78比7.48±1.54,P<0.05〕,ScvO_(2)明显低于NICOM组(0.70±0.03比0.72±0.04,P<0.05)。治疗后6 h起EGDT组复苏液体量即明显高于NICOM组(L:2.89±0.59比2.57±0.64,P<0.05),但同期PaO_(2)/FiO_(2)明显低于NICOM组(mmHg:260.15±76.79比300.25±63.67,P<0.05),治疗后24 h开始EGDT组SOFA评分才明显高于NICOM组(分:11.13±3.85比9.45±3.08,P<0.05),持续到治疗后48 h;EGDT组机械通气时间、ICU住院时间均较NICOM组明显延长〔机械通气时间(h):207.0±107.3比157.8±69.6,ICU住院时间(d):11.30±3.54比9.20±2.95,均P<0.05〕,两组28 d病死率比较差异无统计学意义。结论在EGDT基础上联合NICOM技术引导PLR指导脓毒性休克患者液体复苏,有利于减少复苏液体量,保护器官功能,缩短机械通气时间和ICU住院时间。Objective To evaluate the clinical value of non-invasive cardiac output monitoring(NICOM)combined with early goal-directed therapy(EGDT)in fluid resuscitation for septic shock patients.Methods Eighty patients with septic shock were admitted to the department of critical care medicine of Suzhou Ninth Hospital Affiliated to Soochow University from June 2019 to June 2021.They were divided into EGDT group(n=40)and NICOM group(n=40)according to the random number table method.EGDT group received EGDT fluid resuscitation,and in the NICOM group,NICOM technology was used to guide passive leg raising test(PLR)test on the basis of EGDT to guide fluid resuscitation.The heart rate(HR),mean arterial arterial pressure(MAP),central venous pressure(CVP),urine volume,central venous blood oxygen saturation(ScvO_(2))and blood lactic acid(Lac)were compared between two groups before and 6 hour after treatment,and the volume of fluid resuscitation,oxygention index(PaO_(2)/FiO_(2))and sequential organ failure assessment(SOFA)scores were compared between the two groups at 6,24 and 48 hours after treatment,the duration of mechanical ventilation,length of intensive care unit(ICU)stay and 28 day mortality were compared between the two groups.Results After treatment,HR,MAP,CVP,urine volume,ScvO_(2) and Lac in two groups were significantly improved compared with those before treatment(all P<0.05).Six hours after treatment,the CVP of EGDT group was significantly higher than that of NICOM group[mmHg(1 mmHg≈0.133 kPa):8.35±1.78 vs.7.48±1.54,P<0.05],and ScvO_(2) was significantly lower than that of NICOM group(0.70±0.03 vs.0.72±0.04,P<0.05).From 6 hours after treatment,the resuscitation fluid volume in the EGDT group was significantly higher than that in the NICOM group(L:2.89±0.59 vs.2.57±0.64,P<0.05),however,PaO_(2)/FiO_(2) in the same period was significantly lower than that in the NICOM group(mmHg:260.15±76.79 vs.300.25±63.67,P<0.05).The SOFA score of EGDT group was significantly higher than that of NICOM group from 24 hours after t

关 键 词：无创心排血量监测 早期目标导向治疗 脓毒症 脓毒性休克 被动抬腿试验 

分 类 号：R541.6[医药卫生—心血管疾病]