心肺联合超声监测在重度脓毒症患者液体管理中的应用效果观察  

Observation on the Application Effect of Cardiopulmonary Ultrasound Monitoring in Fluid Management of Patients with Severe Sepsis

作　　者：刘娟 胡丽平 罗冬冬 LIU Juan;HU Liping;LUO Dongdong(Department of Critical Care Medicine,Ji’an Central People's Hospital,Ji’an 343000,China;不详)

机构地区：[1]吉安市中心人民医院重症医学科,江西吉安343000

出　　处：《中国医学创新》2024年第31期98-102,共5页Medical Innovation of China

摘　　要：目的:探讨心肺联合超声监测在重度脓毒症患者液体管理中的应用效果。方法:选取2021年5月—2023年10月吉安市中心人民医院重症医学科收治的重度脓毒症患者70例,以简单随机分组法分为观察组(n=35,心肺联合超声监测指导液体管理)与对照组[n=35,脉搏指示剂连续心排血量(PiCCO)指导液体管理]。比较两组恢复情况[入住重症监护室(ICU)时间、机械通气时间]、28 d病死情况,治疗前后呼吸功能[中心静脉压(CVP)、氧合指数、静态肺顺应性(Cst)、呼气末正压(PEEP)、平台压(Pplat)]、心功能指标[左心室射血分数(LVEF)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)]、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)与序贯器官衰竭评估(SOFA)评分。结果:两组28 d病死率比较,差异无统计学意义(P>0.05);与对照组比较,观察组机械通气时间、入住ICU时间均短,差异均有统计学意义(P<0.05)。治疗3 d后观察组CVP、氧合指数、Cst均较对照组高,PEEP、Pplat均较对照组低,差异均有统计学意义(P<0.05)。观察组治疗3 d后LVEF较对照组高,LVEDV及LVESV均较对照组低,差异均有统计学意义(P<0.05)。治疗3 d后两组APACHEⅡ与SOFA评分均降低,且观察组APACHEⅡ与SOFA评分均较对照组低,差异均有统计学意义(P<0.05)。结论:心肺联合超声监测应用于重度脓毒症患者液体管理中可有效改善患者心肺功能,缓解病情,改善预后。Objective:To explore the application effect of cardiopulmonary ultrasound monitoring in fluid management of patients with severe sepsis.Method:A total of 70 patients with severe sepsis admitted to Department of Critical Care Medicine,Ji’an Central People's Hospital from May 2021 to October 2023 were selected and divided into observation group(n=35,cardiopulmonary ultrasound monitoring to guide fluid management)and control group[n=35,pulse indicator continuous cardiac output(PiCCO)to guide fluid management]by simple randomization method.The recovery situation[intensive care unit(ICU)stay time,mechanical ventilation time],28 d fatality,and respiratory function[central venous pressure(CVP),oxygenation index,static lung compliance(Cst),positive end-expiratory pressure(PEEP),plateau pressure(Pplat)],cardiac function indexes[left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV)],the scores of acute physiology and chronic health evaluationⅡ(APACHEⅡ)and sequential organ failure assessment(SOFA)before and after treatment were compared between the two groups.Result:There was no significant difference in 28 d fatality rate between the two groups(P>0.05).Compared with the control group,the mechanical ventilation time and ICU stay time in the observation group were shorter,the differences were statistically significant(P<0.05).After 3 d of treatment,CVP,oxygenation index and Cst in observation group were higher than those in control group,and PEEP and Pplat were lower than those in control group,the differences were statistically significant(P<0.05).After 3 d of treatment,LVEF in observation group was higher than that in control group,LVEDV and LVESV were lower than those in control group,the differences were statistically significant(P<0.05).After 3 d of treatment,the scores of APACHEⅡand SOFA in both groups were decreased,and the scores of APACHEⅡand SOFA in the observation group were lower than those in the control group,the differences w

关 键 词：心肺联合超声 重度脓毒症 液体管理 中心静脉压 

分 类 号：R459.7[医药卫生—急诊医学]