摘要
目的探究无创全身阻抗法心输出监测系统(NICaS)指导脓毒症休克患者体液复苏前后患者微循环、血流动力学变化。方法选取2017年1月—2019年12月西安高新医院收治的脓毒症休克患者65例,按照随机数字表法分为NICaS组(n=33)和对照组(n=32),对照组采用常规液体复苏,NICaS组在常规复苏基础上联合NICaS指导液体复苏,比较两组复苏前后微循环、血流动力学、并发症及预后不同。结果复苏后NICaS组中心静脉压(CVP)、心率(HR)、乳酸(Las)、中心静脉-动脉二氧化碳氧分压差(Pcv-aCO_(2))水平低于对照组,呼吸频率(RR)、平均血压(MBP)、中心静脉血氧饱和度(SCVO_(2))水平显著高于对照组(均P<0.05);复苏后两组急性生理与慢性健康(APACHEⅡ)评分、序贯器官衰竭(SOFA)评分均下降,且NICaS组显著低于对照组(均P<0.05);NICaS组输液量、去甲肾上腺素用量低于对照组,多巴酚丁胺用量、尿量显著多于对照组(均P<0.05);NICaS组心衰发生率、总并发症发生率、28 d内死亡率均显著低于对照组(均P<0.05)。结论NICaS指导下的液体复苏可有效改善患者微循环灌注和血流动力学,降低患者病死率。
Objective To explore the effects of noninvasive cardiac output measurement system(NICaS)in guiding microcirculation and hemodynamic changes in patients with septic shock before and after resuscitation of body fluids.Methods 65 patients with septic shock admitted to Xi′an Hi-tech Hospital were randomLy divided into 2 groups:control group(n=32)receiving routine body fluid resuscitation and NICaS group(n=33)receiving routine body fluid resuscitation and NICaS in addition.Microcirculation,hemodynamics,complications and prognosis of the two groups were compared before and after resuscitation.Acute physiology and chronic health evaluation(APACHE)APACHEⅡScoring System and Sepsis-related Organ Failure(SOFA)Scoring System were used to evaluate the prognosis.Results After resuscitation,the values of central venous pressure(CVP),heart rate(HR),lactic acid(Las)and central venous-to arterial carbon dioxide difference(Pcv-aCO_(2))of the NicaS group were lower than those of the control group(all P<0.05),while respiratory rate(RR),mean blood pressure(MBP),and central venous oxygen saturation(SCVO_(2))were significantly higher than those of the control group(all P<0.05).The APACHEⅡand SOFA scores in both groups decreased after resuscitation,and both APACHEⅡand SOFA scores of the NicaS group were significantly lower than those of the control group(both P<0.05).Both infusion volume and the norepinephrine consumption of the NICaS group were significantly lower than those of the control group,while the dobutamine dose and urine volume were significantly higher than those of the control group(all P<0.05).The heart failure rate,total complication rate,and mortality within 28 days in the NICaS group were significantly lower than those in the control group(all P<0.05).Conclusion Fluid resuscitation under the guidance of NICaS effectively improves the microcirculation perfusion of patients,promotes hemodynamic stability,and reduces the mortality in the patients with septic shock.
作者
关红
杜俊凯
GUAN Hong;DU Junkai(Emergency Department,Xi′an Hi-tech Hospital,Xi′an Shanxi 710000,China)
出处
《中国急救复苏与灾害医学杂志》
2021年第11期1262-1265,共4页
China Journal of Emergency Resuscitation and Disaster Medicine
