无创超声心排量监测在脓毒症患者液体复苏中的应用研究  

Application of non-invasive ultrasound cardiac output monitoring in fluid resuscitation in patients with sepsis

作　　者：白鹭 陈伟 陆磊 潘亚燕 宋佳星 Lu Bai;Wei Chen;Lei Lu;Yayan Pan;Jiaxing Song(Department of Emergency,The Second Hospital of Jiaxing,Jiaxing 314000,Zhejiang Province,China)

机构地区：[1]嘉兴市第二医院急诊科,嘉兴314000

出　　处：《中国基层医药》2023年第10期1501-1505,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省嘉兴市科技计划(2021AD30100)。

摘　　要：目的探讨无创超声心排血量监测(USCOM)在脓毒症患者液体复苏指导及血流动力学状态评估中的应用效果。方法采用单盲随机对照研究,选取嘉兴市第二医院2021年1月至2022年12月收治的脓毒症患者80例为研究对象,采用随机数字表法分为对照组、观察组各40例。对照组采用监测脉搏波形指示的连续心输出量指导液体复苏和监测血流动力学状态,观察组采用USCOM指导液体复苏和监测血流动力学状态。比较两组入住ICU后24 h、48 h、72 h液体出入量,两组第1、2、3、5、7天动脉血乳酸和氧合指数变化,两组入住ICU时间和住院时间,两组血流动力学指标变化;比较两组28 d死亡情况。结果观察组入住ICU后24 h、48 h、72 h液体出入量分别为(4178.13±327.19)mL、(7763.63±324.08)mL、(10501.38±376.74)mL,均低于对照组的(4527.35±276.84)mL、(8778.15±361.42)mL、(11589.12±413.27)mL(t=5.15、13.22、12.30,均P<0.001)。观察组第1、2、3、5、7天动脉血乳酸水平均低于对照组(t=5.73、6.73、9.98、12.25、14.47,均P<0.001)。两组第1天氧合指数差异无统计学意义(P>0.05),观察组第2、3、5、7天氧合指数均高于对照组(t=-4.31、-8.19、-5.28、-9.44,均P<0.05)。观察组入住ICU时间、住院时间分别为(10.15±2.43)d、(16.51±1.36)d,均短于对照组的(12.75±2.87)d、(17.68±1.59)d(t=4.37、3.54,均P<0.05)。观察组复苏24 h后心输出量、每搏输出量、心指数分别为(5.89±0.51)L/min、(57.71±3.82)mL、(3.31±0.35)L·min^(-1)·m^(-2),均高于对照组的(5.30±0.37)L/min、(50.06±3.25)mL、(2.85±0.34)L·min^(-1)·m^(-2)(t=-5.92、-9.65、-5.96,均P<0.001)。两组28 d病死率差异无统计学意义(P>0.05)。结论USCOM指导脓毒症患者液体复苏及血流动力学状态评估效果显著,可促进患者氧合指数改善,缩短入住ICU时间和住院时间。Objective To investigate the application effects of non-invasive ultrasound cardiac output monitoring(USCOM)in fluid resuscitation guidance and hemodynamic evaluation of patients with sepsis.Methods A total of 80 patients with sepsis who were treated in The Second Hospital of Jiaxing from January 2021 to December 2022 were included in this single-blind randomized controlled study.These patients were randomly divided into a control group(n=40)and an observation group(n=40).In the control group,continuous cardiac output indicated by pulse waveform monitoring was used to guide fluid resuscitation and monitor hemodynamic status,while in the observation group,USCOM was used to guide fluid resuscitation and monitor hemodynamic status.The fluid intake and outflow at 24,48,and 72 hours after admission to the ICU were compared between the two groups.The changes in arterial blood lactate and oxygenation index at 1,2,3,5,and 7 days after admission to the ICU were compared between the two groups.The time of admission to ICU,the length of ICU stay,and changes in hemodynamic indicators were compared between the two groups.The incidence of death within 28 days after admission to the ICU was compared between the two groups.Results The liquid intake and output in the observation group at 24,48,and 72 hours after admission to the ICU were(4178.13±327.19)mL,(7763.63±324.08)mL,and(10501.38±376.74)mL,respectively,which were significantly lower than(4527.35±276.84)mL,(8778.15±361.42)mL,and(11589.12±413.27)mL in the control group(t=5.15,13.22,12.30,all P<0.001).The arterial blood lactate levels in the observation group were significantly lower than those in the control group at 1,2,3,5,and 7 days(t=5.73,6.73,9.98,12.25,14.47,all P<0.001).There was no significant difference in oxygenation index between the two groups on the 1st day(P>0.05).The oxygenation index in the observation group at 2,3,5 and 7 days was significantly higher than that in the control group(t=-4.31,-8.19,-5.28,-9.44,all P<0.05).The time of admission to ICU and

关 键 词：脓毒症 液体复苏 无创超声心排血量监测 血流动力学 液体出入量 乳酸 氧合指数 住院时间 预后 

分 类 号：R459.7[医药卫生—急诊医学]