摘要
目的探讨容量复苏重症患者后期容量变化规律及肺部超声的价值。方法2015年1至6月中山大学附属第一医院重症医学科（ICU）大手术、休克等需要容量复苏的患者40例，从入ICU起动态观察心肺超声，连续7d，监测肺超声B线阳性切面数变化以观察肺水变化趋势，监测左室射血分数（EF）以观察左心收缩功能，测定血NT．proBNP水平早期评估是否心衰，同时记录复苏期间CVP、血清肌酐、液体平衡情况。结果40例患者存活35例，病死5例。共进行床旁心肺超声监测359次，存活患者肺超声B线阳性切面数在12（30）h达高峰，随后开始下降，（39±34）h后下降到零。肺超声B线最高阳性切面数为3（4），B线阳性切面高峰值越高，复苏后期需要的脱水量越多，脱水时间越长。病死患者液体正平衡量大，肺超声B线阳性切面数较存活组明显增多[7（8）比3（4），P〈0．01]，且病程期间肺部B线阳性切面数无下降趋势。存活患者与死亡患者收入ICU时左室EF值分别为69．2％±11．0％与44．5％±3．5％，EF值越低，B线最高阳性切面数越高。与超声B线阳性切面高峰时间[12（30）h]相比，NT-proBNP达到高峰的时间[（44±35）h]较迟，临床上开始脱水治疗的时间同样较B线阳性切面高峰时间[（48．9±27．0）h]延迟。结论容量复苏患者在复苏后期存在容量超负荷，肺超声动态监测B线变化较NT—proBNP及CVP更为敏感精确反映容量变化。
Objective To investigate the clinical value of lung ultrasound in the late goal -directed fluid removal in critically ill patients underwent fluid resuscitation. Methods A prospective study was conducted. Forty patients underwent fluid resuscitation were enrolled in the Department of Surgical Intensive Care Unit of The First Affiliated Hospital of Sun Yat-sen University from Jan 2015 to June 2015. Lung and heart ultrasound were conducted for lung B-lines and left ventricular ejection fraction （EF）. Serum amino- terminal pro-brain natriuretic peptide （NT-proBNP）, central venous pressure （CVP） and serum creatinine were also measured and fluid balance was recorded in all patients enrolled. Results Among the 40 patients enrolled, 35 patients survived and 5 died. In patients survived, B-lines reached its peak at 12 （30）h after admitted to ICU. It started to decrease instantly after the peak and reached zero at （39 -＋ 34） h. A higher peak was followed with more fluids to be removed later and longer ICU stay （ P 〈 0.01 ）. Moreover, when compared with the survivors, B-lines in death reached a higher peak [ 7 （ 8 ） vs 3 （4）, P 〈 0. O1 ] and without the tendency to drop down. EF was lower in death than in survivor （44. 5% ＋3.5% vs 69. 2% ＋ 11.0% , P 〈 O. 05）. A lower EF was found to be followed with a higher peak of B-hnes. The peak time of NT-proBNP and clinical dehydration treatment were later than the peak time of B-lines in survivors. Conclusions Fluid overloading occurs in late stage after resuscitation in critically ill patients. Lung ultrasound B-lines, which is more sensitive than the NT-proBNP and CVP, could help to monitor the patient＇s fluid status and guide the late goal-directed fluid removal.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2016年第17期1359-1363,共5页
National Medical Journal of China
关键词
容量复苏
肺超声
血流动力学
Fluid resuscitation
Lung ultrasound
Hemodynamic
