感染性休克患者应用重症超声联合脉搏指示连续心排血量监测指导液体复苏的效果  

Effect on fluid resuscitation of septic shock patients guided by critical care ultrasound combined with monitoring of pulse indicating continuous cardiac output

作　　者：刘宁宁[1] 王炜璐 李绚璇 于佳[1] LIU Ning-ning;WANG Wei-lu;LI Xun-xuan;YU Jia(Qingdao Hiser Hospital Affiliated of Qingdao University(Qingdao Traditional Chinese Medicine Hospital),Qingdao,Shandong 266000,China)

机构地区：[1]青岛大学附属青岛市海慈医院(青岛市中医医院)功能检查科,山东青岛266033

出　　处：《中华医院感染学杂志》2024年第21期3216-3220,共5页Chinese Journal of Nosocomiology

基　　金：山东省中医药科技基金资助项目(M-2022008)。

摘　　要：目的 探讨感染性休克患者应用重症超声联合脉搏指示连续心排血量(PICCO)监测指导液体复苏的效果。方法 随机将2021年1月-2023年9月青岛大学附属青岛市海慈医院(青岛市中医医院)收治的110例感染性休克患者分为对照组和研究组,均55例。对照组给予PICCO监测指导液体复苏,研究组在对照组基础上增加重症超声,两组均随访30 d。比较两组治疗前和治疗后3 d的体液、细胞免疫功能,治疗前和治疗后24 h的血流动力学及预后情况。结果 两组治疗后3 d的免疫球蛋白(Ig)M、IgA、IgG及CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)较治疗前升高(P<0.05),研究组更高(P<0.05)。两组治疗后24 h的心率较治疗前降低(P<0.05),研究组更低(P<0.05);舒张压、收缩压、平均动脉压升高(P<0.05),研究组更高(P<0.05)。与对照组比,研究组机械通气、重症监护室(ICU)住院时间更短,肺水肿发生率更低(P<0.05)。结论 感染性休克患者应用重症超声联合PICCO监测指导液体复苏可促进体液、细胞免疫功能、血流动力学和预后的改善。OBJECTIVE To explore the effect on fluid resuscitation of the septic shock patients guided by critical care ultrasound combined with monitoring of pulse indicating continuous cardiac output(PICCO). METHODS A total of 110 patients with septic shock who were treated in Qingdao Hiser Hospital Affiliated of Qingdao University(Qingdao Traditional Chinese Medicine Hospital) from Jan. 2021 to Sep. 2023 were enrolled in the study and were randomly divided into the control group and the study group, with 55 cases in each group. The control group treated with fluid resuscitation guided by monitoring of PICCO, and the study group was treated with additional critical care ultrasound on basis of the treatment of the control group. Both groups were followed up for 30 days. The body fluid and cellular immune function indexes were compared between the two groups before the treatment and after the treatment for 3 days;the hemodynamics indexes and prognosis were observed and compared before the treatment and after the treatment for 24 hours. RESULTS The levels of immunoglobin(Ig) M,IgA, IgG, CD_(4)^(+) and CD_(4)^(+)/CD_(8)^(+) of the two groups were significantly higher after the treatment for 3 days than before the treatment(P<0.05), the levels of above indexes of the study group were higher than those of the control group(P<0.05). The heart rate of the two groups was significantly lower after the treatment for 24 hours than before the treatment(P<0.05), and the heart rate of the study group was lower than that of the control group(P<0.05). The diastolic blood pressure, systolic pressure and mean arterial pressure were significantly higher after the treatment than before the treatment(P<0.05), and the above indexes of the study group were higher than those of the control group(P<0.05). The mechanical ventilation duration and length of intensive care unit(ICU) stay were significantly shorter in the study group than in the control group, and the incidence of pulmonary edema of the study group was significantly lower than that of t

关 键 词：感染性休克 重症超声 脉搏指示连续心排血量 液体复苏 免疫功能 

分 类 号：R631.4[医药卫生—外科学]