分钟尿流量监测在脓毒症早期液体复苏中的应用研究

A study on application of minute urine flow monitoring in early fluid resuscitation in patients with sepsis

目的：探讨分钟尿流量监测在脓毒症早期液体复苏中的应用价值。方法选取2014年5月~2016年2月收住重症监护室（ICU）的脓毒症早期液体复苏患者60例，随机分为研究组和对照组；两组患者均按照中华医学会重症医学分会制定的《中国严重脓毒症/脓毒性休克治疗指南（2014）》进行规范化治疗及液体复苏治疗、护理，在此基础上，对照组留置导尿管采用传统的尿量监测法（量杯测量尿量）监测记录尿量，研究组留置导尿管采用分钟尿流量监测仪监测记录尿量，根据测量结果分析、调整液体入量及性质；观察比较两组复苏前、复苏后6 h 的中心静脉压（CVP）、平均动脉压（MAP）、中心静脉血氧饱和度（SCVO2）、尿量变化情况，实现液体复苏目标所需时间及6 h 内液体复苏目标实现率。结果复苏前两组 CVP、MAP、SCVO2、尿量比较差异无统计学意义（P〉0.05）；复苏后6 h 两组CVP、MAP、SCVO2、尿量均较复苏前显著改善（P〈0.01），但研究组改善程度优于对照组（P〈0.01）；研究组实现液体复苏目标所需时间为（3.83±0.83）h，对照组为（5.17±0.92）h，两组比较差异有统计学意义（P〈0.001）；6 h 内实现液体复苏目标研究组为29例，实现率为96.67%，对照组为22例，实现率为73.33%，两组比较差异有统计学意义（ P =0.030）。结论与传统尿量监测方法相比，分钟尿流量监测能更及时、动态、真实反映患者尿量的实际情况，有利于发现患者的血容量变化，及时分析调整恢复有效血容量，更快更有效地实现6 h 内早期液体复苏目标，值得临床推广使用。

Objective To investigate application value of minute urine flow monitoring in early fluid resuscitation in pa-tients with sepsis.Methods 60 patients with sepsis early fluid resuscitation admitted to intensive care unit（ICU）were ran-domly divided into experimental group and control group.Then,standardized treatment,liquid recovery treatment and nursing were given to both groups according Ghina Severe Sepsis/ Septic Shock Treatment Guidelines（2014）formulated by the Critical Care Medicine Branch of Chinese Medical Association.And on this basis,traditional method（measuring cup）was used to mo-nitor and record the urine in the control group indwelling catheters,while the experimental group were given minute uroflowm-etry monitor to monitor and record the urine.Liquid quantity and nature were analyzed and adjusted according to the measure-ment results.In addition,changes of central venous pressure（CVP）,mean arterial pressure（MAP）,central venous oxygen sat-uration（SCVO2 ）and urine volume before resuscitation and 6 h after resuscitation as well as time required to achieve the goal of fluid resuscitation and target realization rate of fluid resuscitation within 6 h were observed and compared.Results There was no statistically significant difference between CVP,MAP,SCVO2 and urine volume of the two groups before resuscitation （P〉0.05）.However,CVP,MAP,SCVO2 and urine volume of the two groups all significantly improved 6 h after resuscitation （P〈0.01）,and those of the experimental group improved more significantly than those of the control group（P〈0.01）.Time＆nbsp;required to achieve the goal of fluid resuscitation was（3.83±0.83）h in the experimental group,and（5.17±0.92）h in the con-trol group,so difference was statistically significant（P〈0.001）.29 cases in the experimental group realized goal of fluid resus-citation within 6 h,the realization rate was 96.67%,and 22 cases in the control group realized it,and the realization rate was 73.33%,so difference was statistically significant（P= 0.030）.Conclusion Compared with the traditional method of monito-ring urine,minute uroflowmetry can reflect the actual urine volume of patients more timely,dynamically and truly.In addition, It is conducive to the discovery of blood volume changes in patients,timely analyze,adjust and restore the effective blood vol-ume,and realize goal of fluid resuscitation within 6 h faster and more effectively.Thus,it is worthy of promotion in clinical practice.