无创血流动力学监测在严重脓毒症患者早期液体复苏治疗中的作用研究

Role of non-invasive hemodynamic monitoring in early fluid resuscitation of patients with severe sepsis

目的探讨无创血流动力监测法(ICG)在指导严重脓毒症患者液体复苏及血管活性药应用中的作用。方法选取2012年1月-2012年12月在该院重症医学科住院治疗的严重脓毒症患者37例为常规组(A组);选取2013年1月-2013年12月在该院重症医学科住院治疗的严重脓毒症患者43例为对照组(B组)。A组以严重脓毒症的集束化治疗为指导进行治疗。B组则在集束化治疗为指导的基础上,以ICG监测指导进行液体复苏及血管活性药物的使用。观察6 h后平均动脉压(MAP)、中心静脉压(CVP)、血乳酸值<2 mmol/L和中心静脉血氧饱和度(Scv O2)>70%的比例、液体平衡、血管活性药物用量;ICU住院时间。结果在液体复苏前,两组患者的年龄、性别、病因、APACHEⅡ评分、血流动力学状态比较,差异无统计学意义;A组与B组液体复苏6h后Scv O2、血乳酸值比较差异无统计学意义(P>0.05)。但A组与B组比较,6 h液体复苏的量明显增多;血管活性药物去甲肾上腺素及多巴酚丁胺用量明显减少(P<0.05)。但ICU住院时间B组则明显缩短(P<0.05)。结论以ICG监测指导严重脓毒症患者液体复苏及血管活性药应用,能更精确进行液体管理,减少盲目补液,缩短ICU住院时间。

[Objective] To explore the role of non-invasive hemodynamie monitoring method （ICG） in the guidance of fluid resuscitation and vasoaetive drug application to patients with severe sepsis. [Methods] Thir- ty-seven severe sepsis patients hospitalized in the ICU of our hospital from January 2012 to December 2012 were selected for the conventional group （group A）; while forty-three severe sepsis patients hospitalized from January 2013 to December 2013 without severe edema or severe obesity were selected for the control group （group B）. Group A was treated by cluster treatment of severe sepsis as a guide. Group B was also treated by cluster treatment of severe sepsis as a guide, together with ICG guided liquid recovery and vasoaetive drug application. Mean arterial pressure, central venous pressure, the proportion of patients with blood lactate value 〈 2 mmol/L and central venous oxygen saturation 〉 70%, the fluid balance and vasoactive drug dosage were observed 6 h after the therapies. The ICU hospitalization time was recorded. [Results] There were no statisti- cal differences in the age, gender, etiology, APACHE II score or hemodynamic status between both groups before fluid resuscitation. The central venous oxygen saturation and blood lactate value showed no significant differences between both groups 6 h after fluid recovery （P 〉 0.05）. Compared with the group B, the amount of fluid resuscitation significantly increased whereas norepinephrine dosage and dobutamine dosage significantly redoced （P〈 0.05） in the group A within 6 hours. However, the ICU hospitalization time significantly reducedin the group B （P 〈 0.05）. [Conclusion] With ICG guided liquid recovery and vasoactive drug application to patients with severe sepsis, more accurate fluid management can be obtained, blind rehydration can be re- duced and the time of ICU stay can be shortened.