不同液体复苏策略对脓毒性休克患者预后的影响

Effect of different fluid resuscitation scheme on the prognosis of patients with septic shock

目的比较限制性和开放性液体复苏策略对脓毒性休克患者预后的影响。方法将46例脓毒性休克患者随机分为开放组和限制组各23例,开放组实施开放性液体复苏策略,限制组实施限制性液体复苏策略。比较2组血流动力学指标、APACHEⅡ和SOFA评分、心功能及心肌损伤改善情况,CRP水平的变化,以及60 d病死率、机械通气时间、入住ICU时间和无脏器衰竭时间的差异。结果复苏后2组HR、MAP、CVP及血乳酸水平改善幅度差异无统计学意义;限制组APACHEⅡ评分、SOFA评分、心功能指标、心肌损伤指标和CRP水平的改善幅度均显著大于开放组(P<0.05或P<0.01)。开放组60 d病死率有高于限制组的趋势,但差异无统计学意义(P>0.05),限制组住ICU时间和机械通气时间均显著短于开放组(P<0.05或P<0.01)。结论早期限制性液体复苏策略可有效改善并维持脓毒性休克患者血流动力学的稳定,与开放性液体复苏策略相比,其在降低病死率、缩短ICU入住时间、改善心功能以及减少心肌损伤方面均有一定优势。

Objective It is to compare the effects of limited fluid resuscitation and open fluid resuscitation on the prognosis of patients with septic shock. Methods 46 cases of patients with septic shock were randomly divided into open group（ n = 23）which was given open fluid resuscitation and limited group（ n = 23） which was given limited fluid resuscitation. The changes of hemodynamics indexes,APACHE Ⅱ,SOFA scores,CRP level,the improvements of cardiac function,cardiac muscle damage,and 60 d mortality,the duration of ventilatory support and ICU stay,and duration with no organ failure were compared in both groups. Results After resuscitation,there was no significant difference in the improvements of HR,MAP,CVP and blood lactic acid; The improvements of APACHE II scores,SOFA scores,cardiac function indexes,cardiac muscle damage indexes and CRP were more significantly in limited group than those in open group（ P〈0.05 or P〈0.01）. 60 d mortality in open group was higher than that in limited group,but the difference was not significant（ P〉0.05）. The duration of ICU stay and ventilatory support were significantly shorter in limited group than that in open group（ P〈0.05 or P〈0.01）. Conclusion Early limited fluid resuscitation could effectively improve and maintain the stability of hemodynamics in the patients with septic shock,and it had some advantages in decreasing mortality,shortening duration of ICU stay,improving cardiac function and relieving cardiac muscle damage compared with open fluid resuscitation.