摘要
目的:通过观察对比限制性液体负平衡治疗方法和开放性液体治疗方法在急性呼吸窘迫综合征(ARDS)治疗过程中的优劣性,为ARDS患者的液体治疗提供循证依据。方法:筛选2017-01-2020-05期间入住我院重症医学科诊断上符合2012年柏林会议要求的ARDS标准的患者84例进行前瞻性研究。随机分为观察组42例和对照组42例。观察组给予限制性液体负平衡治疗方法,对照给予开放液体治疗方法,记录两组治疗7 d的液体净入量;比较两组治疗开始时及治疗后48 h的氧合指数(OI)、平均动脉压(MAP)、中心静脉压(CVP)、血乳酸(Lac)及APACHEⅡ评分;观察两组治疗时间及28 d生存率。结果:观察组在治疗后第2~7天液体净入量少于对照组(P<0.05);在治疗48 h后,两组MAP、CVP在组内及组间比较无明显差异(P>0.05),观察组OI较对照组升高,而EVLWI、Lac及APACHEⅡ评分则降低(P<0.05);观察组机械通气时间、住ICU时间较对照组明显减少,同时28 d生存率高于对照组(P<0.05)。结论:在严密监测血流动力学的基础上实施限制性液体负平衡治疗,可以减少ARDS患者的液体输入量,减轻肺水肿,对改善氧合指数,缩短机械通气及住ICU时间,提高患者生存率有积极作用。
Objective:To provide evidence for the fluid therapy of ARDS by observing and comparing the advantages and disadvantages of restrictive fluid negative balance therapy and open fluid therapy in the treatment of ARDS.Method:A total of 84 patients diagnosed with ARDS according to Berlin Conference of 2012 who were admitted to the intensive care department of our hospital from January 2017 to May 2020 were selected for prospective study.Patients were randomly divided into observation group(42 cases)and control group(42 cases).The observation group was administered with restrictive fluid negative balance therapy and the control group was administered with open fluid therapy.The net fluid intake during 7 days of treatment of the two groups was recorded.The oxygenation index(OI),mean arterial pressure(map),central venous pressure(CVP),blood lactic acid(LAC)and APACHEⅡscores were compared between the two groups at the beginning of treatment and 48 hours after treatment.The treatment duration and28-day survival rate of the two groups were observed.Result:The net liquid intake in the observation group was less than that in the control group on the 2 nd to 7 th day of treatment(p<0.05).After 48 hours of treatment,there was no significant difference in MAP and CVP between the two groups(P>0.05).OI in the observation group was higher than that in the control group,while EVLWI,Lac and APACHEⅡscores were lower than that in the control group(P<0.05).Compared with the control group,the duration of mechanical ventilation and ICU stay in the observation group were significantly reduced,and the 28-day survival rate was higher(P<0.05).Conclusion:On the basis of close monitoring of hemodynamics,restrictive fluid negative balance therapy could reduce fluid input in patients with ARDS,decrease pulmonary edema,improve oxygenation index,shorten the duration of mechanical ventilation and ICU stay,and improve the survival rate.
作者
赵千文
李秋红
谢玉萍
ZHAO Qianwen;LI Qiuhong;XIE Yuping(Department of Intensive Care Unit,Hainan Branch of Tongren Hospital,Affiliated to Shanghai Jiaotong University School of Medicine,Qiongzhong,Hainan,572900,China)
出处
《临床急诊杂志》
CAS
2020年第9期707-710,共4页
Journal of Clinical Emergency
关键词
限制性液体负平衡
急性呼吸窘迫综合征
治疗方法
restrictive fluid negative balance
acute respiratory distress syndrome
therapy
