连续性血流动力学监测对感染性休克药物应用的指导作用

The role of continuous hemodynamic monitoring in the treatment of septic shock

目的探讨连续性血流动力学监测下对感染性休克血管活性药物应用的指导价值。方法随机选取广州市番禺区中心医院2016年3月至2018年3月确诊的感染性休克患者50例,所有患者治疗前及治疗后6、12、24、48、72 h内监测患者的血流动力学指标,包括每搏变异度(SVV)、心排量(CO)、外周血管阻力(SVR)以及每搏量(SV),根据血流动力学指标调控血管活性药物的使用。结果治疗后24、48和72 h的SVV和SVR均小于治疗后6 h和治疗前,而治疗后48和72 h的CO和SV均大于治疗后6 h和治疗前。多巴酚丁胺在治疗后12 h时开始应用,在治疗后48 h时共6例需要同时使用多巴酚丁胺+去甲肾上腺素,乳酸钠林格在治疗后24 h时开始降低补液量。患者液体复苏成功共41例,成功率82.0%,其中1例并发肺水肿,发生率为2.0%。结论连续性的血流动力学监测有助于及时采取合理的补液和使用血管活性药物,保证了治疗的有效性和持续性,安全可行。

Objective To explore the guiding value of continuous hemodynamic monitoring for the application of vasoactive drugs in septic shock. Methods 50 patients with septic shock were randomly selected; hemodynamic indexes were measured, including stroke volume variation(SVV) and cardiac output(CO), systemic vascular risistance(SVR) and stroke volume(SV) before treatment and after treatment for 6, 12, 24,48 and 72 hours, according to the vascular hemodynamic parameters to regulate the use of active drug. Results SVV and SVR of 24-72 hour were less than those of 6 hour and before treatment, while CO and SV were both greater than those 6 hour and before treatment(P<0.05).Dobutamine was first applied at 12 hour, and dobutamine + norepinephrine was simultaneously used in 6 cases at 48 hour,and ringer of lactate started to reduce the amount of fluid replenishment at 24 hour. There were 41 cases of successful fluid resuscitation with a success rate of 82.0%, including 1 case(2.0%) with pulmonary edema. Conclusion Continuous hemodynamic test is helpful for timely taking rational fluid infusion and using vasoactive drugs,which ensures the effectiveness and sustainability of treatment and is safe and feasible.