早期液体复苏对感染性休克患者血流动力学的影响

Effects of early fluid resuscitation on hemodynamic parameters in septic shock patients

目的分析早期液体复苏对感染性休克患者血流动力学的影响。方法选取2011年1月至2012年4月我院ICU收治的26例感染性休克患者作为研究对象,随机分为对照组和试验组,各13例。两组患者均采用PICCO监测,并根据早期复苏目标导向疗法(early goal directed therapy,EGDT)进行早期液体复苏治疗。对照组和试验组复苏液分别为林格液和6%羟乙基淀粉130/0.4氯化钠溶液。分别于复苏开始时(0 h)、8 h和24 h收集患者的血流动力学参数。结果试验组和对照组的CVP、CI、ITBVI及GEDVI水平均随着时间的增加上升(P<0.05),但EVLWI在对照组明显增加(P<0.05),而试验组无明显变化。除试验组EVLWI外,与开始复苏(0 h)相比较,试验组和对照组的CVP、CI、ITBVI、GEDVI及对照组的EVLWI与开始复苏(0 h)相比较均有明显差异(P<0.05)。经重复测量资料的方差分析发现,试验组CVP和GEDVI较对照组上升水平明显,对照组EVLWI较试验组上升水平明显,差异均具有统计学意义(P<0.05)。结论感染性休克患者根据EGDT方案使用6%羟乙基淀粉130/0.4氯化钠溶液进行复苏,能更好地改善患者的血流动力学指标。

Objective To study the effects of early fluid resuscitation on hemodynamic parameters in septic shock patients. Methods From January 2011 to April 2012, 26 patients with septic shock were selected from ICU admission. Patients were randomly divided into control group （13 cases） and treatment group （13 cases）. All patients received PICCO monitoring, and early goal directed therapy （EGDT） was applied to conduct early fluid resuscitation. Resuscitation fluids used for control and treatment group were ringer and 6% 130/0.4 sodium chloride hydroxyethyl starch solution, respectively. Hemodynamic parameters were collected at 0 h, 8 h and 24 h after recovery. Results The level of CVP, CI, ITBVI and GEDVI raised with time for both groups （P〈0.05）, but only EVLWI increased significantly in control group （P〈0.05）. Compared with 0 h after resuscitation, CVP, CI, ITBVI and GEDVI for both group and EVLWI for control group increased significantly （all P〈0.05）. Repeated measure ANOVA found that CVP and GEDVI levels for both group and EVLWI for control group increased, the difference was statistically significant （all P〈0.05）. Conclusion Using 6% 130/0.4 sodium chloride hydroxyethyl starch solution for patients with septic shock to recover according to EGDT could better improve the patient＇s hemodynamic indices.