胸腔内血容量指数指导下的液体复苏对机械通气下脓毒症休克患者预后的影响

Effect of fluid resuscitation under guidance of intrathoracic blood volume index on prognosis of septic shock patients with mechanical ventilation

目的评价胸腔内血容量指数(ITBVI)指导下的液体复苏对机械通气下脓毒症休克患者预后的影响。方法将65例机械通气下脓毒症休克患者随机分成两组:中心静脉压(CVP)组(对照组),CVP目标值≥12mmHg(1mmHg=0.133kPa)和试验组,ITBVI目标值≥850ml/m2。统计每例患者前5天的液体入量、机械通气时间、ICU住院时间,比较两组28天病死率。结果 ITBVI组前5天的液体入量明显少于CVP组,(16 567±971)ml vs(19 072±1 232)ml(P<0.05);机械通气时间和ICU住院时间均短于CVP组,分别为(5.05±1.67)天vs(5.94±1.38)天(P<0.05),和(7.74±1.80)天vs(8.70±1.69)天(P<0.05);28天病死率两组的差异无统计学意义。结论在机械通气下脓毒症休克患者中使用ITBVI指导液体复苏能缩短患者的机械通气时间、ICU住院时间。

Objective To evaluate the effect of fluid resuscitation under the guidance of intrathoracic blood volume index（ITBVI） on the prognosis of septic shock patients with mechanical ventilation. Methods 65 septic shock patients with mechanical ventilation were divided into ITBVI group（experimental） and central venous pressure（CVP） group（control） randomly.The target value of ITBVI was ≥850 ml/m2 and that of CVP was ≥12 mmHg.The fluid intake of the first 5 days,time of mechanical ventilation,ICU length of stay were counted and the 28 day mortality was compared between two groups. Results The fluid intake of ITBVI group was significantly less than that of CVP group,（16 567±971） ml vs（19 072±1 232） ml（P0.05）;time of mechanical ventilation and ICU length of stay were shorter than those of control group,（5.05±1.67）d vs（5.94±1.38） d（P0.05）,（7.74±1.80） d vs（8.70±1.69） d（P0.05）.There was no significant difference in 28 day mortality between two groups. Conclusion For the septic shock patients with mechanical ventilation,fluid resuscitation under the guidance of ITBVI can shorten the time of mechanical ventilation and ICU length of stay.