超声指导容量复苏在重症创伤患者中应用的研究  

Application of ultrasound-guided volume resuscitation in severe trauma patients

作　　者：代莉 郭华静 邓恢伟 DAI Li;GUO Huajing;DENG Huiwei(Department of Anesthesiology,Changde Hospital,Xiangya School of Medicine,Central South University,Changde 415003,China)

机构地区：[1]中南大学湘雅医学院附属常德医院麻醉科,湖南常德415003

出　　处：《新医学》2024年第5期354-359,共6页Journal of New Medicine

基　　金：常德市科技创新指导项目(2022ZD35)。

摘　　要：目的探讨超声指导容量复苏在重症创伤患者救治中的应用价值。方法选择需要手术治疗的重症创伤患者60例,按随机数表法分为超声指导容量复苏组(U组)和经验治疗对照组(C组),每组30例。所有患者入室后立即进行全身麻醉诱导、中心静脉穿刺并开始手术。U组分别在患者入室后即刻、麻醉诱导后、手术结束时及苏醒后进行超声检查,测量下腔静脉直径(IVC)、主动脉根部峰流速变异(ΔV_(peak))、主动脉根部速度时间积分变异(ΔVTI),并根据超声检查结果指导液体复苏。C组根据心率、平均动脉压、中心静脉压、液体负荷试验、血气分析结果等进行液体复苏。于2组患者入室后即刻(T_(0))、入室后1 h(T_(1))、2 h(T_(2))、4 h(T_(3))、6 h(T_(4))、24 h(T_(5))采集桡动脉血,检测乳酸浓度,并进行血气分析。观察患者入室后0~<1 h、1~<2 h、2~<4 h、4~6 h、0~6 h输入晶体液总量、胶体液总量和血制品量。记录患者手术时间、麻醉时间、苏醒时间、拔管时间、出血量、尿量、低血压持续时间、高乳酸浓度持续时间、住院时间、转ICU率、28 d病死率及去甲肾上腺素使用总量。结果与T_(0)比较,U组患者乳酸浓度在T_(1)、T_(2)时升高,T_(4)时降至正常浓度;C组乳酸浓度在T_(1)~T_(3)时升高,T_(5)时降至正常浓度。与C组比较,U组乳酸浓度在T_(2)、T_(3)时较低,去甲肾上腺素使用总量较少、高乳酸浓度持续时间较短,U组0~<1 h输入晶体液量较多,2~<4 h、4~6 h及0~6 h输入晶体液量较少,2~<4 h及0~6 h输入胶体液量较少,组间比较差异均有统计学意义(P均<0.05);而2组患者的手术时间、麻醉时间、苏醒时间、拔管时间、住院时间、术中出血量、输入血制品量、氧合指数、尿量、低血压持续时间等比较差异均无统计学意义(P均>0.05)。结论超声指导下容量复苏可安全用于重症创伤患者,能减少输液总量和血管活性药物总量、�Objective To investigate the role of ultrasound-guided volume resuscitation in the treatment of severe trauma.Methods Sixty patients with severe trauma requiring surgical intervention were included and randomly assigned into the ultrasoundguided volume resuscitation group(group U,n=30)and the empirical treatment group(group C,n=30)using the random number table method.All patients underwent general anesthesia induction,central venous catheterization and subsequent surgery.In group U,ultrasound examination was conducted for assessing the inferior vena cava(IVC),aortic root peak velocity variation(ΔVpeak)and time integral variation of aortic root velocity(ΔVTI)upon arrival at the operating room,after general anesthesia induction,at the end of operation and upon resuscitation,respectively.Fluid resuscitation therapy in group U was guided based on these results.In group C,patients were subjected to fluid resuscitation based on heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),fluid load test and blood gas analysis results,etc.Radial artery blood samples were collected from all patients immediately upon arrival at the OR(T_(0)),at 1 h(T_(1)),2 h(T_(2)),4 h(T_(3)),6 h(T_(4)),and 24 h(T_(5))post-arrival,and lactate levels along with other blood gas analysis results were recorded accordingly.Additionally,the total amount of crystalloids and colloids administered from 0-<1 h,1-<2 h,2-<4 h,4-6 h,and 0-6 h since arrival were documented.The operation time,anesthesia duration,postoperative recovery time,extubation time,blood loss volume,urine output,duration of hypotension,duration of elevated lactate levels,length of hospital stay,ICU transfer rate,28-d mortality rate,and the total amount of norepinephrine use were recorded.Results Compared with T_(0),lactate levels in group U exhibited an increase at T_(1) and T_(2),and followed by a return to normal levels at T_(4).In group C,an elevation in lactate levels was demonstrated at T_(1)~T_(3),which subsequently decreased to normal levels at T_(5).Patients

关 键 词：超声 容量复苏 重症创伤 下腔静脉直径 乳酸 

分 类 号：R641[医药卫生—外科学]