摘要
目的探讨床旁超声及脉搏指示剂连续心排血量监测(PiCCO)引导下液体复苏治疗脓毒性休克的效果及安全性。方法选择2019年1月至2023年5月淄博世博高新医院收治的80例脓毒症休克患者作为研究对象,按随机数表法分为观察组和对照组各40例。两组患者均接受脓毒症休克常规治疗,对照组患者在此基础上使用PiCCO引导下液体复苏治疗,观察组患者使用床旁超声引导下液体复苏治疗。比较两组患者的复苏6 h达标率、机械通气时间、住ICU时间、住院时间及治疗6 h、12 h后的复苏液体量、尿量;比较两组患者治疗前、治疗6 h后的平均动脉压(MAP)、中心静脉压(CVP)、中心静脉血氧饱和度(ScvO2);同时比较两组患者的肺水肿发生率及28 d死亡率。结果观察组患者的机械通气时间、住ICU时间分别为(3.29±0.54)d、(5.43±0.69)d,明显短于对照组的(4.31±1.03)d、(6.04±0.76)d,差异均有统计学意义(P<0.05),而两组患者的复苏6 h达标率、住院时间比较差异均无统计学意义(P>0.05);观察组患者治疗6h、12 h后的复苏液体量分别为(1484.23±210.34)mL、(2034.32±275.83)mL,明显少于对照组的(1722.87±246.93)mL、(2311.17±355.95)mL,尿量分别为(237.34±30.41)mL、(432.50±73.81)mL,明显多于对照组(178.43±21.73)mL、(517.23±79.45)mL,差异均有统计学意义(P<0.05);治疗6 h后,两组患者MAP、CVP、ScvO2均高于治疗前,差异均有统计学意义(P<0.05),但两组患者治疗6 h后的MAP、CVP、ScvO2比较差异均无统计学意义(P>0.05);观察组患者的肺水肿发生率为5.00%,明显低于对照组的20.00%,差异有统计学意义(P<0.05);观察组患者的28 d死亡率为17.50%,略低于对照组的22.50%,但差异无统计学意义(P>0.05)。结论与PiCCO相比,床旁超声引导下液体复苏能缩短脓毒症患者的机械通气时间、住ICU时间,减少液体复苏量及肺水肿的发生率,安全性更好。
Objective To investigate the efficacy and safety of bedside ultrasound-and pulse indicator continu-ous cardiac output monitoring(PiCCO)-guided fluid resuscitation in the treatment of septic shock.Methods A total of 80 patients with septic shock admitted to Zibo Shibo High-tech Hospital from January 2019 to May 2023 were selected and divided into an observation group and a control group,with 40 cases in each group,according to random number ta-ble method.Based on routine treatment for septic shock,patients in the control group received liquid resuscitation treat-ment guided by PiCCO,and patients in the observation group received liquid resuscitation treatment guided by bedside ultrasound.The recovery 6-hour compliance rate,mechanical ventilation time,length of ICU stay,length of hospital time,resuscitation fluid volume and urine volume after 6 h and 12 h after treatment were compared between the two groups.The changes of mean arterial pressure(MAP),central venous pressure(CVP),and central venous oxygen satura-tion(ScvO2)before and 6 h after treatment were also compared.The incidence of pulmonary edema and 28 d mortality rate were compared between the two groups.Results The mechanical ventilation time and length of ICU stay in the ob-servation group were(3.29±0.54)d and(5.43±0.69)d,which were significantly shorter than(4.31±1.03)d and(6.04±0.76)d in the control group(P<0.05).There was no statistically significant difference in the recovery 6-hour compliance rate and length of hospital stay between the two groups(P>0.05).The resuscitation fluid volume in the observation group at 6 h and 12 h after treatment were(1484.23±210.34)mL and(2034.32±275.83)mL,which were significantly lower than(1722.87±246.93)mL and(2311.17±355.95)mL in the control group;the urine volume were(237.34±30.41)mL and(432.50±73.81)mL,which were significantly higher than(178.43±21.73)mL and(517.23±79.45)mL in the control group;the difference were statistically significant(P<0.05).At 6 h after treatment,the MAP,CVP,and ScvO2 of the two
作者
元文琪
杨文倩
严莉娟
YUAN Wen-qi;YANG Wen-qian;YAN Li-juan(Intensive Care Unit,Zibo Shibo High-tech Hospital,Zibo 255000,Shandong,CHINA;Department of Ultrasound,Zibo Shibo High-tech Hospital,Zibo 255000,Shandong,CHINA)
出处
《海南医学》
CAS
2024年第8期1076-1080,共5页
Hainan Medical Journal
基金
山东省科学技术发展计划项目(编号:2016GGH219041)。
关键词
脓毒性休克
液体复苏
超声
脉搏指示剂连续心排血量监测
机械通气
肺水肿
安全性
Septic shock
Fluid resuscitation
Ultrasound
Pulse indicator continuous cardiac output monitoring(PiCCO)
Mechanical ventilation
Pulmonary edema
Safety
