心肺超声指导的液体治疗对脓毒性休克患者预后的影响  

Impact of cardiopulmonary ultrasound-guided fluid therapy on outcomes in patients with septic shock

作　　者：郑义丽 余琨 贺小霞 刘鑫鑫 梅鸿 冯帮海 覃松 程丽婷 Zheng Yili;Yu Kun;He Xiaoxia;Liu Xinxin;Mei Hong;Feng Banghai;Qin Song;Cheng Liting(Department of Respiratory and Critical Care Medicine,Bozhou District People's Hospital,Zunyi 563100,China;Department of Critical Care Medicine,Affiliated Hospital of Zunyi Medical University,Zunyi 563000,China;Department of Critical Care Medicine,Zunyi Hospital of Traditional Chinese Medicine,Zunyi 563000,China;Department of Critical Care Medicine,Guizhou Moutai Hospital,Renhuai 564500,China)

机构地区：[1]播州区人民医院呼吸与危重症医学科,贵州遵义563100 [2]遵义医科大学附属医院重症医学科,贵州遵义563000 [3]遵义市中医院重症医学科,贵州遵义563000 [4]贵州茅台医院重症医学科,贵州仁怀564500

出　　处：《中华卫生应急电子杂志》2024年第6期325-331,共7页Chinese Journal of Hygiene Rescue(Electronic Edition)

基　　金：贵州省科技计划项目(黔科合基础-ZK-2022-660,ZK-2023-544);遵义市科技与大数据局科学技术基金项目(遵市科合HZ字(2023)221号,(2023)199号);贵州茅台医院科研项目(MTyk2022-17、MTyk2022-24)。

摘　　要：目的观察心肺超声联合指导的液体管理与目标导向治疗对脓毒性休克患者疗效的影响。方法选取2023年3月至2024年12月期间于遵义医科大学附属医院住院诊断为脓毒性休克的患者96例,按照随机数字表法随机分为心肺超声引导的液体治疗组(超声组)和目标导向治疗组(GDT组),每组48例,其中男性59例,女性37例;年龄21~80岁,中位年龄56.5(44.0,68.0)岁。收集患者入院时的基线资料,超声组患者分别于入组时(0 h),治疗后24、48及72 h行超声检查心脏收缩舒张功能、下腔静脉直径及其扩张指数和肺部情况引导液体治疗,GDT组根据中心静脉压(CVP)、平均动脉压(MAP)、中心静脉血氧饱和度(ScvO2)、尿量、乳酸(Lac)联合指导液体管理,比较两组患者的基线资料、复苏液体量、NT-proBNP变化情况,观察结局指标,包括24 h复苏达标率、乳酸清除率(24、48及72 h)、机械通气时间、ICU住院时间、总住院时间、ICU病死率、28 d病死率。结果随着治疗时间延长,两组患者的心率和NT-proBNP逐渐下降、MAP均逐渐升高(P<0.05)。与GDT组比较,心肺超声引导的液体复苏能提高24 h复苏达标率,增加24、48及72 h乳酸清除率,减少24及48 h液体复苏量,增加48及72 h的出量、平衡量及尿量,加快NT-proBNP下降,但两组患者间机械通气时间、重症监护病房(ICU)住院时间、总住院时间、ICU病死率及28 d病死率比较差异均无统计学意义(P>0.05)。结论心肺超声可用于指导脓毒性休克患者的液体管理,提高24 h复苏达标率和乳酸清除率,减少复苏液体量,使NT-proBNP明显下降,心肌损伤减轻。Objective To observe the impact of cardiopulmonary ultrasound-guided fluid resuscitation and goal-directed therapy on the prognosis of patients with septic shock.Methods A total of 96 patients diagnosed with septic shock hospitalized in Affiliated Hospital of Zunyi Medical University from March 2023 to December 2024 were selected and randomly divided into cardiopulmonary ultrasoundguided fluid therapy group(ultrasound group)and goal-directed therapy group(GDT group)according to random number table,with 48 patients in each group.Among them,there were 59 males and 37 females and the age ranged from 21 to 80 years,with a median age of 56.5(44.0,68.0)years.The baseline data of patients at admission were collected.The patients in the ultrasound group underwent critical care ultrasound examination,including cardiac systolic and diastolic function,inferior vena cava diameter and dilatation index,and lung condition at the time of admission(0 h),24 h,48 h and 72 h after treatment,respectively,to guide fluid therapy.GDT group guided fluid management according to central venous pressure(CVP),mean arterial pressure(MAP),central venous oxygen saturation(ScvO2),urine volume and lactic acid(Lac).Clinical data,fluid volume,NT-proBNP changes of the two groups were compared and prognostic indicators were observed,including 24-hour resuscitation targeting rate,lactate clearance rate(24 h,48 h,72 h),mechanical ventilation time,length of intensive care unit(ICU)and hospital stay,mortality within ICU and 28 days.Results With the prolongation of treatment,the heart rate and NT-proBNP of the two groups gradually decreased,and the MAP gradually increased(P<0.05).Compared with the GDT group,the fluid resuscitation guided by the cardiopulmonary ultrasound could increase the 24 h resuscitation targeting rate,increase lactate clearance rate at 24 h,48 h and 72 h,reduce the volume of fluid resuscitation at 24 hours and 48 hours,increase output,fluid balance and urine volume of 48h and 72 h,and accelerate the decline of NT-proBNP.There were no

关 键 词：脓毒性休克 重症超声 液体复苏 NT-PROBNP 

分 类 号：R459.7[医药卫生—急诊医学]