超声监测下腔静脉内径在创伤失血性休克患者指导液体复苏中的临床价值  

Clinical value of ultrasonic monitoring inferior vena cava diameter in guiding fluid resuscitation of patients with traumatic hemorrhagic shock

作　　者：莎日娜 耿立霞[1] SHA Ri-na;GENG Li-xia(Department of Critical Care Medicine,the First Affiliated Hospital of Baotou Medical College,Inner Mongolia University of Science and Technology,Baotou 014010,China)

机构地区：[1]内蒙古科技大学包头医学院第一附属医院重症医学科,014010

出　　处：《中国实用医药》2023年第22期64-68,共5页China Practical Medicine

摘　　要：目的分析超声监测下腔静脉(IVC)内径在创伤失血性休克患者指导液体复苏中的应用价值。方法80例创伤失血性休克患者,随机分为观察组和对照组,每组40例。观察组采用超声监测IVC内径指导液体复苏治疗,对照组采用常规液体复苏治疗。比较两组患者复苏前后的复苏指标[平均动脉压(MAP)、中心静脉压(CVP)、中心静脉血氧饱和度(ScvO_(2))]及观察组复苏前后下腔静脉变异度(IVCV)、下腔静脉塌陷指数(IVC-CI)水平,复苏前后的乳酸水平,血管活性药物用量和输血量,预后情况。结果复苏后2、6、12、24 h,两组MAP、CVP、ScvO_(2)均高于本组复苏前,且观察组复苏后2、6、12、24 h的MAP均高于对照组,复苏后12 h的CVP高于对照组,复苏后6、12、24 h的ScvO_(2)均高于对照组,差异具有统计学意义(P<0.05)。观察组复苏后2、6、12、24 h的IVCV均低于复苏前,复苏后24 h的IVC-CI低于复苏前,差异具有统计学意义(P<0.05)。复苏后6、12、24 h,观察组乳酸水平分别为(4.55±1.04)、(3.34±1.25)、(1.43±0.76)mmol/L,均低于对照组的(6.60±1.03)、(5.37±2.67)、(3.38±1.12)mmol/L,差异具有统计学意义(P<0.05)。观察组多巴胺、5%碳酸氢钠、去氧肾上腺素、悬浮红细胞、血浆用量分别为(96.25±18.07)mg、(78.68±10.02)ml、(67.34±8.25)mg、(5.28±1.67)U、(688.55±13.04)ml,均少于对照组的(120.61±21.18)mg、(150.67±21.02)ml、(80.37±9.67)mg、(8.82±2.35)U、(835.60±25.03)ml,差异具有统计学意义(P<0.05)。观察组病死率和肺水肿、急性呼吸窘迫综合征发生率分别为5.0%、7.5%、12.5%,均低于对照组的20.0%、25.0%、32.5%,差异具有统计学意义(P<0.05)。结论对于创伤失血性休克患者,采用超声监测IVC内径指导液体复苏可以准确的评估患者的血容量,更加有效适量的对患者进行补液,改善患者的预后情况。Objective To analyze the value of ultrasonic monitoring inferior vena cava(IVC)diameter in guiding fluid resuscitation of patients with traumatic hemorrhagic shock.Methods A total of 80 patients with traumatic hemorrhagic shock were randomly divided into the observation group and the control group,with 40 cases in each group.In the observation group,IVC diameter was monitored by ultrasound to guide fluid resuscitation,while in the control group,conventional fluid resuscitation was performed.Comparison was made on resuscitation indexes[mean arterial pressure(MAP),central venous pressure(CVP),central venous oxygen saturation(ScvO_(2))]before and after resuscitation between the two groups,as well as the levels of inferior vena cava variation(IVCV),inferior vena cava collapse index(IVC-CI),lactic acid level before and after resuscitation,vasoactive drug dosage and blood transfusion volume and prognosis of the observation group.Results MAP,CVP and ScvO_(2) in both groups at 2,6,12 and 24 h after resuscitation were higher than those before resuscitation in this group;MAP in the observation group at 2,6,12 and 24 h after resuscitation were higher than those of the control group,CVP at 12 h after resuscitation was higher than that of control group,and ScvO_(2) at 6,12 and 24 h after resuscitation were higher than those of the control group.The differences were statistically significant(P<0.05).In the observation group,IVCV at 2,6,12 and 24 h after resuscitation were lower than those before resuscitation in this group,and IVC-CI at 24 h after resuscitation was lower than that before resuscitation in this group.The differences were statistically significant(P<0.05).At 6,12 and 24 h after resuscitation,the lactic acid levels in the observation group were(4.55±1.04),(3.34±1.25)and(1.43±0.76)mmol/L,which were lower than those of(6.60±1.03),(5.37±2.67)and(3.38±1.12)mmol/L in the control group,and the differences were statistically significant(P<0.05).The dosage of dopamine,5%sodium bicarbonate,deoxyadrenaline,suspended r

关 键 词：超声监测 下腔静脉内径 创伤失血性休克 液体复苏 预后 

分 类 号：R605.971[医药卫生—急诊医学]