超声VTI引导液体复苏治疗ARDS伴右心功能不全的效果研究  

Study on the effect of ultrasound VTI-guided fluid resuscitation in patients with ARDS accompanied by right heart dysfunction

作　　者：吕有凯 吉晓霞 云天奇 LYU Youkai;JI Xiaoxia;YUN Tianqi(Department of Emergency,the Second Affiliated Hospital of Hainan Medical College,Haikou Hainan 570311,China)

机构地区：[1]海南医学院第二附属医院急诊科,海南海口570311 [2]海南医学院第二附属医院神经内科,海南海口570311

出　　处：《中国急救复苏与灾害医学杂志》2025年第2期207-211,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：海南省医药卫生科研项目(编号:19030942)。

摘　　要：目的以常规中心静脉压(CVP)指导下复苏为对照,研究超声左心室流出道速度时间积分(VTI)引导液体复苏应用于急性呼吸窘迫综合征(ARDS)伴右心功能不全的价值。方法按照随机数字表法将2021年7月—2023年8月海南医学院第二附属医院收治的80例ARDS伴右心功能不全患者分为CVP组、VTI组,各40例。CVP组在常规CVP指导下进行液体复苏,VTI组在超声VTI引导下进行液体复苏。比较两组复苏前后急性生理学和慢性健康状况评分(APACHEⅡ)、序贯器官衰竭评分(SOFA)、中心静脉压(CVP)、心指数、每搏输出量指数(SVI)、脉搏血氧饱和度(SpO_(2))、氧合指数、动脉氧分压(PaO_(2))、血乳酸、pH值、机械通气时间、液体复苏量、ICU住院时间、去甲肾上腺素用量、血管外肺水指数(ELWI)、肺毛细血管通透性指数(PVPI)。结果VTI组复苏后APACHEⅡ、SOFA评分与CVP组比较,差异无统计学意义(P>0.05);VTI组复苏后CVP、心指数、SVI、SpO_(2)高于CVP组(t=2.137、2.540、2.134,P=0.036、0.013、0.036);VTI组复苏后氧合指数、PaO_(2)、血乳酸、pH值与CVP组比较,差异无统计学意义(P>0.05);VTI组24 h液体复苏量高于CVP组,24 h去甲肾上腺素用量低于CVP组(t=2.492、6.914,P=0.015、0.000);VTI组复苏后ELWI、PVPI与CVP组比较,差异无统计学意义(P>0.05);两组均无肺水肿等不良反应发生。结论与常规CVP相比,超声VTI引导液体复苏应用于ARDS伴右心功能不全,对复苏量把控更精准,能避免液体复苏不充分,有效改善血流动力学,减少血管活性药物的使用。Objective To study the value of left ventricular outflow tract velocity-time integrals(VTI)guided fluid resuscitation in acute respiratory distress syndrome(ARDS)with right ventricular insufficiency,compared with conventional central venous pressure(CVP)guided resuscitation.Methods According to random number table method,80 patients with ARDS with right heart insufficiency admitted to the Second Affiliated Hospital of Hainan Medical College from July 2021 to August 2023 were divided into CVP group and VTI group,40 cases each.The CVP group performed liquid resuscitation under the guidance of conventional CVP,and the VTI group performed liquid resuscitation under the guidance of ultrasonic VTI.Acute physiological and chronic health scores(APACHEⅡ),Sequential Organ failure score(SOFA),Central venous pressure(CVP),cardiac index,stroke output index(SVI),pulse oxygen saturation(SpO_(2)),oxygenation index,arterial partial oxygen pressure(PaO_(2)),blood lactic acid,pH value,mechanical ventilation time,fluid resuscitation volume,ICU stay time,norepinephrine dosage,extravascular pulmonary water index(ELWI),pulmonary capillary permeability index(PVPI)before and after resuscitation were compared between the two groups.Results After resuscitation,there was no statistically significant difference in APACHEⅡand SOFA scores between the VTI group and the CVP group(P>0.05).However,the VTI group exhibited higher CVP,cardiac index,SVI,and SpO_(2) values compared to the CVP group(t=2.137,2.540,2.134,P=0.036,0.013,0.036,respectively).Additionally,the VTI group had higher oxygenation index,PaO_(2),blood lactate,and pH values compared to the CVP group,but these differences were not statistically significant(P>0.05).The VTI group also consumed more fluid resuscitation and used less norepinephrine in 24 hours compared to the CVP group(t=2.492,6.914,P=0.015,0.000,respectively).There was no statistically significant difference in ELWI and PVPI between the VTI group and the CVP group after resuscitation(P>0.05).Neither group experienced

关 键 词：超声 速度时间积分 液体复苏 急性呼吸窘迫综合征 右心功能不全 中心静脉压 

分 类 号：R605.974[医药卫生—急诊医学]