全心舒张末期容积指数在脓毒性休克早期液体复苏中的应用

Application of global end-diastolic volume index in the early fluid resuscitation of patients with septic shock

目的探讨全心舒张末期容积指数(global end-diastolic volumn index,GEDI)在脓毒性休克早期液体复苏中的应用价值。方法选取入住连云港市某人民医院重症监护病房(intensive care unit,ICU)的28例脓毒性休克患者,随机分为常规组和脉搏指示持续心输出量(pulse indicator continuous cardiac output,Pi CCO)组。常规组采用2012年脓毒性休克集束化治疗方案进行液体复苏。Pi CCO组根据GEDI指导补液,维持GEDI 650~800 ml/m^2,记录入ICU即刻血乳酸浓度、中心静脉-动脉二氧化碳分压差(central venous-to-arterial carbon dioxide difference,Pcv-a CO_2)、6 h血乳酸浓度及Pcv-a CO_2,并计算6 h乳酸清除率,比较两组患者6、24、48、72 h液体正平衡量,记录两组撤离呼吸机时间、ICU停留时间、28 d病死率。结果 Pi CCO组入ICU6h血乳酸浓度(t=2.24,P=0.034)、6 h Pcv-a CO_2(t=2.18,P=0.038)、6 h乳酸清除率(t=4.40,P<0.05)与常规组不同,差异有统计学意义;Pi CCO组6 h内使用液体正平衡量显著多于常规组(t=2.85,P=0.008),但48 h(t=4.22,P<0.05)、72 h液体量正平衡量(t=5.01,P<0.05)明显少于常规组;Pi CCO组撤离呼吸机时间(t=5.61,P<0.05)及ICU停留时间(t=2.38,P=0.025)明显缩短。两组28 d病死率差异无统计学意义(χ2=0.18,P=0.430)。结论通过GEDI指导补液能改善感染性休克患者的组织缺氧情况,避免盲目补液,缩短机械通气时间及ICU停留时间。

Objective This study was designed to investigate tile application of global end-diastolic volume index in early fluid resuscitation of patients with septic shock. Methods Twenty-eight patients with septic shock admitted to intensive care unit （ICU） of a people＇ s hospital in Lianyungang city were randomly divided into conventional group and PiCCO group. The patients in conventional group were given fluid resuscitation according to surviving sepsis bundles 2012. The patients in PiCCO group were given fluid resuscitation according to global end-diastolic volume index （GEDI）, and GEDI was maintained between 680-800 ml/m. Blood concentration of lactate and Pcv-aCO2 after immediate admission to ICU, blood concentration of lactate and Pcv-aCO2 were detected 6 hours after admission to ICU, 6-honrs lactate clearance rate were calculated. The amounts of positive fluid balance at 6, 24, 48 and 72 hours of resuscitation were compared between the two groups. The duration mechanical ventilation,the duration of ICU stay and the 28-day mortality were compared between the two groups. Results There were significant differences in 6-hour lactate （t=2.24, P=0.034）, 6-hour Pcv-aCO2 （t=2.18, P=0.038） and 6-hour lactate clearance rate （t=4.40, P〈0.05） after admission to ICU between the two groups. The amount of positive fluid balance at 6 hours of PiCCO group was greater than that of conventional treatment group （t=2.85, P=0.O08）, but the amount of positive fluid balance at 48 hours （t=4.22, P〈O.05）, 72 hours （t=5.01, P〈0.05） of PiCCO group reduced significantly as compared with conventional treatment group. The duration of mechanical ventilation （t=5.61, P〈0.05） and the duration of ICU stay （t=2.38, P=0.025） shortened significantly. There were no significant differenc.es of the 28-day mortality between the two groups （X2=0.18, P=0.430 ）. Conclusions Global end-diastolic w）lume index can improve hypoxia of septic shock, avoid blind infusion, and reduce the duration mechanical ventilation and ICU length of stay.