早期液体复苏对老年感染性休克患者血管外肺水的影响

Effects of early fluid resuscitation on extravascular lung water of elderly patients with septic shock

目的探讨老年感染性休克患者不同液体早期复苏对血流动力学及血管外肺水(extravascular lungwater,EVLW)的影响。方法将22例老年感染性休克患者随机分为A组(n=11)和B组(n=11),两组患者均按早期复苏目标导向治疗(early goal-directed therapy,EGDT)方案复苏,A组予6%羟乙基淀粉130/0.4溶液(万汶)+0.9%生理盐水复苏,B组予0.9%生理盐水复苏;分别于复苏前、复苏6 h、复苏24 h、复苏48 h收集血流动力学参数及血管外肺水数据,并记录复苏后6、24和48 h液体复苏达标情况。结果两组复苏后均可以显著改善感染性休克的血流动力学指标,血乳酸(Lac)水平显著下降(P<0.05)。A组比较B组在复苏过程中更早(6小时)出现胸腔内血容量指数(ITBVI)显著升高(P<0.05),肺血管渗透性指数(PVPI)、血管外肺水指数(ex-travascular lung water index,EVLWI)在液体复苏过程中均无显著改变(P>0.05),B组EVLWI在复苏48 h显著升高(P<0.05)。两组患者EVLWI与全心舒张末期容积指数(GEDVI)、胸内血容量指数(ITBVI)及氧合指数(PO2/FiO 2)间均无明显的相关关系,与PVPI均有明显的正相关关系(A组:r=0.823,PP<0.01,B组:r=0.629,P<0.01)。结论老年感染性休克患者无论使用胶体或晶体液进行液体复苏,都可以改善感染性休克的血流动力学状态;且胶体液有更好的扩容效果,能更好的维持血浆胶体渗透压;老年感染性休克患者晶体液复苏有导致EVLW增加的危险。

【Objective】 To determine the effect of fluid resuscitation on haemodynamic and extravascular lung water（EVLW） of elderly patients in early stage of septic shock.【Methods】 Twenty-two elder1y patients with septic shock were randomly divided into group A（n =11） and group B（n =11）.Patients of two groups were given fluid resuscitation by early goal-directed therapy（EGDT）.Group A was given fluid resuscitation of 6%hydroxyethyl starch130/0.4（VOLUVEN）-0.9%NaCl solution and group B of 0.9%NaCl solution.The data of haemodynamic and extravascular lung water was collected at the point before fluid resuscitation and 6 hour,24 hour,48 hour after the beginning of fluid resuscitation.【Results】 Fluid resuscitation significantly improved the hemodynamics of two groups＇ patients with septic shock.Blood lactic acid（Lac） decreased significantly after fluid resuscitation in both groups（P 0.05）.Intrathoracic blood volume index（ITBVI） of the patients in group A significantly increased more early（6 hour） compared with patients in group B（P 0.05）.There was no change in PVPI,EVLWI in the course of fluid resuscitation of two groups（P 0.05）.EVLWI of group B significantly increased 48 hour after beginning of fluid resuscitation（P 0.05）.EVLWI was not significantly correlated with GEDVI,ITBVI,PO2/FiO2,but positively correlated with PVPI（group A： r =0.823,P 0101,group B： r =0.629,P 0.01）.【Conclusion】 Fluid resuscitation of both colloid and crystalloid could improved the hemodynamics of septic shock in critical patients.But colloid could better remain colloid osmotic pressure and expend blood volume compared with crystalloid.EVLW maybe increase in fluid resuscitation of crystal in elder1y patients with septic shock.