床旁超声与脉搏指示连续心输出量指导脓毒性休克患者行液体复苏的比较效果研究  

Comparative effectiveness research of bedside ultrasound and pulse indicator PiCCO volume in guiding patients with septic shock to undergo fluid resuscitation

作　　者：哈迎鹏 黄之娇 李吉明[1] HA Ying-peng;HUANG Zhi-jiao;LI Ji-ming(Intensive Care Unit,Emergency and Trauma Center,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;不详)

机构地区：[1]新疆医科大学第一附属医院急救·创伤中心重症监护室,新疆乌鲁木齐830054 [2]新疆医科大学第一附属医院手术室,新疆乌鲁木齐830054

出　　处：《中国医学装备》2023年第12期134-138,共5页China Medical Equipment

基　　金：新疆维吾尔自治区卫生健康青年医学科技人才专项科研项目(WJWY-202017)“脓毒症休克所致急性肾损伤的肾脏血流动力学及氧代谢变化”。

摘　　要：目的:比较分析床旁超声与脉搏指示连续心输出量(PiCCO)指导脓毒性休克患者行液体复苏的临床效果。方法:前瞻性选取2020年4月至2022年3月新疆医科大学第一附属医院收治的104例脓毒性休克患者,采取随机数表法将其分为PiCCO组和床旁超声组,每组52例,PiCCO组以PiCCO监测为依据进行早期液体复苏治疗,床旁超声组以床旁超声为依据指导早期液体复苏治疗。患者在不同的模式下进行液体管理治疗,对比两组患者治疗前后血流动力学参数指标、量表评分变化,同时对比两组患者预后参数指标。结果:PiCCO组和床旁超声组治疗后24 h心输出量指数(CI)值分别为3.11±0.81和3.45±0.76、全心射血分数(GEF)(15.87±4.11)%和(17.78±5.03)%、全心舒张末期容积指数(GEDVI)值824.55±145.14和890.24±160.88、胸腔内血容积指数(ITBVI)值1057.84±156.98和1173.22±160.77、血管外肺水指数(EVLWI)值10.87±3.24和12.11±2.99均高于同组治疗前,差异均有统计学意义(tPiCCO=3.635,t=4.025,t=3.998,t=4.364,t=2.998;t床旁超声组=21.459,t=20.838,t=25.925,t=25.955,t=18.214;P<0.05);治疗后24 h床旁超声组CI值、GEF值、GEDVI值、ITBVI值和EVLWI值均高于PiCCO组,差异均有统计学意义(t=2.307,t=2.120,t=2.186,t=3.702,t=2.028;P<0.05)。床旁超声组急性生理学和慢性健康评估系统(APACHE-Ⅱ)评分、序贯器官衰竭评分(SOFA)评分均低于PiCCO组,差异均有统计学意义(t=6.952,t=9.739;P<0.05)。两组治疗后24 h与治疗前相比APACHE-Ⅱ和SOFA评分均较低,治疗后24 h床旁超声组与PiCCO组相比APACHE-Ⅱ和SOFA评分均较低,差异有统计学意义(t=3.028,t=5.687;P<0.05)。两组感染发病率、机械通气时间、ICU治疗时间以及30 d内病死率相比,差异无统计学意义(P>0.05)。结论:床旁超声与PiCCO用于脓毒症休克患者实施液体复苏的治疗均可获得显著的效果,且在预后表现上并无明显的差异性。Objective:To explore and analyze the effects of bedside ultrasound and continuous cardiac output(PiCCO)volume in guiding patients with septic shock to undergo fluid resuscitation.Methods:A total of 104 patients with septic shock admitted to the First Affiliated Hospital of Xinjiang Medical University from April 2020 to March 2022 were prospectively selected as research objects,and they were divided into PiCCO group and bedside ultrasound group by random number table method,with 52 cases in each group.The patients of the two groups underwent fluid management therapy in different modes.And then,the changes of the indicators of hemodynamic parameters and scale scores before and after treatment were compared between the two groups.At the same time,the indicators of prognostic parameters of the two groups were compared.Results:The cardiac output(CI)values(3.11±0.81 and 3.45±0.76),glomerular filtration(GEF)rates(15.87±4.11 and 17.78±5.03),global end-diastolic volume index(GEDVI)values(824.55±145.14 and 890.24±160.88),intrathoracic blood volume index(ITBVI)values(1057.84±156.98 and 1173.22±160.77)and extra vascular lung water index(EVLWI)values(10.87±3.24 and 12.11±2.99)of PiCCO group and bedside ultrasound group at the 24th hours after treatment were respectively higher than those before treatment,the differences were statistically significant(tPiCCO=3.635,t=4.025,t=3.998,t=4.364,t=2.998,tbedside ultrasound group=21.459,t=20.838,t=25.925,t=25.955,t=18.214,P<0.05).The CI value,GEF value,GEDVI value,ITBVI value and EVLWI value in the bedside ultrasound group were respectively higher than those in the PiCCO group at the 24th hours after treatment,and the differences were statistically significant(t=2.307,t=2.120,t=2.186,t=3.702,t=2.028,P<0.05).Both the scores of Acute Physiology and Chronic Health Evaluation(APACHE-Ⅱ)System and the scores of Sequential Organ failure score(SOFA)in the bedside ultrasound group were lower than those in the PiCCO group,and the differences were statistically significant(t=6.952,t=9

关 键 词：床旁超声 脉搏指示连续心输出量 脓毒性休克 液体复苏 

分 类 号：R816.1[医药卫生—放射医学]