早期限制性液体复苏治疗重症肺炎合并感染性休克的效果观察  

Effect of early restrictive fluid resuscitation in the treatment of severe pneumonia combined with septic shock

作　　者：冯铭 Feng Ming(Department of Critical Care,Changzhou Geriatric Hospital affiliated to Soochow University,Changzhou Seventh People's Hospital,Changzhou,Jiangsu 213011,China)

机构地区：[1]苏州大学附属常州老年病医院,常州市第七人民医院重症医学科,江苏常州213011

出　　处：《感染、炎症、修复》2025年第1期30-33,共4页Infection Inflammation Repair

摘　　要：目的:分析早期限制性液体复苏治疗应用于重症肺炎合并感染性休克的医学价值。方法:100例研究对象为苏州大学附属常州老年病医院于2023年1月至12月收治的重症肺炎合并感染性休克患者,按照随机抽样分组法平均分为两组,一组开展常规治疗(对照组,50例),另一组给予早期限制性液体复苏治疗(观察组,50例)。比较两组患者治疗前后炎性因子水平、凝血功能以及休克期恢复时间等指标。结果:治疗后,两组IL-4、IL-12以及γ干扰素等炎性因子水平低于治疗前,且观察组治疗后低于对照组(P<0.05),提示观察组患者炎性反应改善更明显。治疗后,两组活化部分凝血活酶时间、凝血酶原时间均升高,纤维蛋白原和凝血酶时间均下降,且观察组改善优于对照组(P<0.05),提示观察组患者内源性凝血功能恢复优于对照组。观察组休克期恢复时间、总补液量、机械通气时间以及血管活性药物使用时间均低于对照组(P<0.05)。两组治疗前格拉斯哥预后评分(GOS)、格拉斯哥昏迷评分(GCS)无统计学差异(P>0.05),治疗后观察组两项指标改善均优于对照组(P<0.05),提示观察组患者意识清醒状态改善和预后优于对照组。结论:对于重症肺炎合并感染性休克,在常规治疗措施基础上开展早期限制性液体复苏治疗,可以迅速降低患者体内炎性因子水平,调节患者凝血功能,缩短患者休克改善时间,有助于患者康复。Objective:To analyze the medical value of early restrictive fluid resuscitation therapy in patients with severe pneumonia combined with septic shock.Methods:A total of 100 patients with severe pneumonia combined with septic shock admitted to Changzhou Geriatric Hospital affiliated to Soochow University from January 2023 to December 2023 were included in the study.The patients were divided into two groups according to the randomized sampling method,with 50 cases in each group.One group received routine treatment(the control group),while the other group received early restrictive fluid resuscitation(the observation group).Inflammatory factors,coagulation function,and the time of recovery from shock were compared between the two groups before and after treatment.Results:After treatment,levels of inflammatory factors such as IL-4,IL-12,and gamma interferon were lower than before treatment,and the observation group was lower than the control group after treatment(P<0.05),indicating that inflammatory response of patients in the observation group was improved more significantly.After treatment,the activated partial thromboplastin time and prothrombin time increased,while the fibrinogen and thrombin time decreased in both groups,and the improvement in the observation group was better than that in the control group(P<o.05),indicating that the endogenous coagulation function recovery in the observation group was better than that in the control group.The time of recovery shock,the total amount of fluid supplementation,the time of mechanical ventilation,and the time of vasoactive drug use in the observation group were lower than those of control group(P<0.05).Glasgow prognosis score(GOS)and Glasgow coma score(GCS)before treatment had no statistical difference between the two groups(P>0.05),and the improvement of the two indexes in the observation group was better than that in the control group after treatment(P<0.05),indicating that the improvement of consciousness and prognosis in the observation group were better than thos

关 键 词：液体复苏 早期 限制性 肺炎 重症 休克 感染性 凝血功能 炎性因子 

分 类 号：R563.1[医药卫生—呼吸系统]