FloTrac/Vigileo系统联合被动抬腿试验在老年感染性休克患者液体复苏中的应用

Application of Flo Trac/Vigileo System Combined with Passive Leg Raising for Fluid Resuscitation of Elderly Patients with Septic Shock

目的:观察Flo Trac/Vigileo系统联合被动抬腿试验(PLR)在指导老年感染性休克患者液体复苏中的应用效果。方法:54例老年感染性休克患者随机分为中心静脉压组(CVP组)、每搏量组(SV组)及PLR组,在接受常规感染性休克治疗基础上,分别监测CVP、SV及PLR时的SV值,观察3组患者液体复苏后6 h及24 h的乳酸(Lac)、脑钠肽(BNP)、氧合指数(PO2/Fi O2,P/F)和补液量,同时比较血管活性药物平均使用时间及28 d生存率。结果:液体复苏6 h时,CVP组补液量和BNP值均明显高于SV组及PLR组(P<0.05),Lac和P/F差异无统计学意义(P>0.05),SV组与PLR组间Lac、BNP、P/F及补液量差异无统计学意义(P>0.05);24 h补液量,CVP组>SV组>PLR组,组间比较差异有统计学意义(P<0.05);P/F,CVP组<SV组<PLR组,组间比较差异有统计学意义(P<0.05);PLR组BNP低于CVP组及SV组,差异有统计学意义(P<0.05),CVP组与SV组间差异无统计学意义(P>0.05);3组患者的Lac、使用血管活性药物平均时间及28 d生存率的差异无统计学意义(P>0.05)。结论:Flo Trac/Vigileo系统联合被动抬腿试验在指导老年感染性休克液体复苏治疗中比传统CVP监测更精确。

Objective：To investigate the effect of fluid resuscitation guided by FloTrac/Vigileo System combined with passive leg raising （PLR） for elderly patients with septic shock.Methods：Fifty-four elderly patients with septic shock were randomly divided into 3 groups.Besides the conventional treatment,they were respectively monitored by CVP （CVP group）,stroke volume （SV group） and PLR group.SV value of the three groups were monitored.Lactate （Lac）,brain natriuretic peptide （BNP）,oxygenation index （PO2/FiO2,P/F） and the volume of fluid input in 6 h and 24 h after fluid resuscitation were tested,and comparing the mean time of the application of vasoactive drugs and 28-day survival rates of the patients.Results：At 6 h after fluid resuscitation,the volume of fluid input and BNP value in CVP group were much higher than SV and PLR group（P ＜0.05）,while there was no significant difference in Lac and P/F levels（P ＞0.05）.The difference was not significant in Lac,BNP P/F and input fluid between SV and PLR group （P ＞ 0.05） ; and over 24 h,volume of fluid input were as follows：CVP group ＞ SV group ＞ PLR group,group comparison differences were statistically significant （P ＜ 0.05） ; P/F：CVP group ＜ SV group ＜ PLR group （P ＜ 0.05）,BNP：PLR group was lower than CVP group and SV group （P ＜ 0.05）.Differences between CVP and SV groups were not statistically significant（P ＞ 0.05）.There was no statistical differences in Lac level and average time usage of vasoactive drugs among the three groups,survival rate after 28 d were not statistically significant（P ＞ 0.05）.Conclusions：Fluid therapy monitored by FloTrac/Vigileo system combined with passive leg raising test in elderly patients with septic shock is more effective.