液体负平衡管理在感染性休克合并急性肺损伤患者早期复苏中的应用效果

Application effects of negative fluid balance in early resuscitation of patients with septic shock combined with acute lung injury

目的:观察液体负平衡管理在感染性休克(SS)合并急性肺损伤(ALI)患者早期复苏中的应用效果。方法:选取2019年5月至2021年5月该院收治的60例SS合并ALI患者进行前瞻性研究,按照随机数字表法分为对照组和研究组各30例。对照组实施液体出入平衡或适当正平衡管理,研究组实施液体负平衡管理,比较两组治疗前后心功能指标[中心静脉压(CVP)、平均动脉压(MAP)、心脏指数(CI)]水平、肺功能指标[氧合指数(PaO_(2)/FiO_(2))、血管外肺脏水指数(ELWI)]水平、症状评分[急性生理学及慢性健康状况量表(APACHEⅡ)]及预后情况。结果:治疗后,两组CVP、CI水平比较,差异均无统计学意义(P>0.05),研究组MAP水平低于对照组,差异有统计学意义(P<0.05);研究组PaO_(2)/FiO_(2)、ELWI水平均高于对照组,差异有统计学意义(P<0.05);研究组APACHEⅡ评分低于对照组,差异有统计学意义(P<0.05);研究组机械通气时间、ICU住院时间均短于对照组,差异有统计学意义(P<0.05);两组MODS发生率、28 d病死率比较,差异均无统计学意义(P>0.05)。结论:液体负平衡管理应用于SS合并ALI患者,可提高其心肺功能水平,改善临床症状,缩短机械通气时间,促进预后恢复,其效果优于液体出入平衡或适当正平衡管理。

Objective:To observe application effects of negative fluid balance in early resuscitation of patients with septic shock(SS)combined with acute lung injury(ALI).Methods:A prospective study was conducted on 60 patients with SS combined with ALI who were admitted to this hospital from May 2019 to May 2021.They were divided into control group and study group according to the random number table method,30 cases in each group.The control group was given fluid in and out balance or proper positive balance management,while the study group was given negative fluid balance management.The cardiac function index levels[central venous pressure(CVP),mean arterial pressure(MAP),cardiac index(CI)],the pulmonary function index levels[oxygenation index(PaO_(2)/FiO_(2)),extravascular lung water index(ELWI)],the symptom score[acute physiology and chronic health evaluation scoring system(APACHE II)]and the prognosis recovery conditions were compared between the two groups before and after the treatment.Results:After the treatment,there were no significant differences in the CVP and CI levels between the two groups(P>0.05).The level of MAP in the study group was lower than that in the control group,and the difference was statistically significant(P<0.05).The levels of PaO_(2)/FiO_(2) and ELWI in the study group were higher than those in the control group,and the differences were statistically significant(P<0.05).The APACHE II score of the study group was lower than that of the control group,and the difference was statistically significant(P<0.05).The mechanical ventilation time and the ICU stay time in the study group were shorter than those in the control group,and the differences were statistically significant(P<0.05).There were no significant differences in the incidence of MODS and 28-day mortality rate between the two groups(P>0.05).Conclusions:The negative fluid balance management for the patients with SS combined with ALI can improve the levels of cardiopulmonary function,improve the clinical symptoms,shorten the mechanical ventilation time,and promote the prognosis recovery.Moreover,it is superior to fluid in and out balance or proper positive balance management.