外科感染性休克患者应用无创实时动脉压及血流动力学监测的效能及其对应激反应的影响  

Efficacy of non-invasive real-time arterial pressure and hemodynamic monitoring in surgical septic shock patients and its impact on stress response

作　　者：李风 胡宏鸯 Li Feng;Hu Hongyang(Department of General Surgery,Xin’an International Hospital,Jiaxing 314000,China)

机构地区：[1]浙江省新安国际医院普外科,嘉兴314000

出　　处：《中华实验外科杂志》2024年第1期124-127,共4页Chinese Journal of Experimental Surgery

基　　金：浙江省医药卫生科技计划项目(2021KY1118)。

摘　　要：目的观察外科感染性性休克患者应用无创实时动脉压及血流动力学监测的应用价值及其对应激反应的影响。方法选取2019年9月至2023年3月浙江省新安国际医院外科救治感染性休克患者46例,采用前瞻性随机对照方案,将患者随机分为两组,每组各23例。治疗组使用无创实时动脉压及血流动力学监测为治疗提供依据,对照组使用常规监测治疗方法,比较两组平均平均动脉压(MAP)、中心静脉压(CVP)、氧合指数(PaO_(2)/FiO_(2))、中心静脉血氧饱和度(ScvO_(2))和乳酸清除率分别在6、12、24 h时点的表达水平;比较两组皮质醇(Cor)、肾上腺素(E)和促肾上腺皮质激素(ACTH)分别在外科感染性休克第1天、第2天和第3天应激反应表达水平差异。结果治疗组MAP在6、12、24 h时间点表达水平高于对照组[(5.1±1.8、8.0±1.6和10.2±1.3)比(4.5±1.9、5.2±1.8和8.4±1.3),t=21.345、17.625和15.235,P<0.05];治疗组CVP在6、12、24 h时间点表达水平高于对照组[(57.1±6.5、59.2±5.9和63.1±6.0)比(50.3±11.2、57.3±7.9和58.6±7.1),t=6.421、5.702、5.235,P<0.05)];治疗组PaO_(2)/FiO_(2)在6、12、24 h时间点表达水高于对照组[(247.4±11.2、311.2±8.7和335.0±8.5)比(212.5±10.5、284.2±10.2和301.2±8.7),t=15.302、12.211、11.357,P<0.05)];治疗组ScvO_(2)在6、12、24 h时间点表达水平高于对照组[(59.5±6.8、68.7±6.9和73.2±5.7)比(52.3±7.1、60.6±4.9和61.3±7.6),t=15.271、14.365、12.108,P<0.05)];治疗组乳酸清除率在6、12、24 h时间点表达水平低于对照组[(2.37±0.63、1.80±0.57和1.50±0.37)比(3.60±0.67、2.90±0.69和2.50±0.42,t=5.723、3.623、2.721,P<0.05]。治疗组Cor在外科感染性休克第1天、第2天和第3天表达水平低于对照组[(310.51±25.53、359.38±26.96和400.41±27.85)比(340.35±27.09、390.56±35.88和430.45±36.74),t=14.041、16.415、18.107,P<0.05)],两两比较结果显示,与对照组Cor水平比较,治疗组患者的相关指标水平降低,组间差Objective Exploring the application value of non-invasive real-time arterial pressure and hemodynamic monitoring in patients with surgical septic shock and its impact on stress response.Methods Selecting 46 patients with septic shock treated surgically in our hospital from September 2019 to March 2023 were selected,and a prospective randomized controlled plan was adopted,randomly divide the patients into two groups,with 23 cases in each group.The treatment group used non-invasive real-time arterial pressure and hemodynamic monitoring as the basis for treatment,while the control group used conventional monitoring treatment methods,Compare the expression levels of mean arterial pressure(MAP),central venous pressure(CVP),oxygenation index(PaO_(2)/FiO_(2)),central venous oxygen saturation(ScvO_(2)),and lactate clearance rate between two groups at 6,12,and 24 h,respectively.Compare the differences in stress response between two groups of cortisol(Cor),epinephrine(E),and adrenocorticotropic hormone(ACTH)on the 1st,2nd,and 3rd day of surgical septic shock,respectively.Results The expression levels of MAP in the treatment group were higher than those in the control group at 6,12 and 24 h[(5.1±1.8,8.0±1.6 and 10.2±1.3)vs.(4.5±1.9,5.2±1.8 and 8.4±1.3),t=21.345,17.625,15.235,P<0.05];The expression levels of CVP in the treatment group were higher than those in the control group at 6,12 and 24 h[(50.1±6.5,59.2±5.9 and 63.1±6.0)vs.(57.3±11.2,57.3±7.9 and 58.6±7.1),t=6.421,5.702,5.235,P<0.05];The expression of PaO_(2)/FiO_(2) in the treatment group was higher than that in the control group at 6,12 and 24 h[(247.4±11.2,311.2±8.7 and 335.0±8.5)vs.(212.5±10.5,284.2±10.2 and 301.2±8.7),t=15.302,12.211,11.357,P<0.05];The expression level of ScvO_(2) in the treatment group was higher than that in the control group at 6,12 and 24 h[(59.5±6.8,68.7±6.9 and 73.2±5.7)vs.(52.3±7.1,60.6±4.9 and 61.3±7.6),t=15.271,14.365,12.108,P<0.05];The expression level of lactate clearance in the treatment group at 6,12 and 24 h w

关 键 词：感染性休克 血流动力学监测 应激反应 

分 类 号：R459.7[医药卫生—急诊医学]