床旁超声指导感染性休克患者液体复苏的研究

STUDY OF FLUID RESUSCITATION IN PATIENTS WITH SEPTIC SHOCK GUIDED BY BEDSIDE ULTRASOUND

目的以床旁超声监测感染性休克患者下腔静脉内径(IVC)、左室舒张末期容积(LVEDV),指导患者液体复苏,探讨床旁超声指导感染性休克患者液体复苏的临床价值。方法选择该院重症医学科感染性休克患者112例,采用床旁超声指导液体管理,容量控制机械通气下行床旁超声测量呼气末、吸气末下腔静脉最大内径(IVCmax)、最小径(IVCmin),计算出下腔静脉呼吸变异指数(RVI),测量左室舒张末期容积(LVEDV);测CVP,PiCCO导管法测定胸腔内血容量指数(ITBVI)、血管外肺水指数(EVLWI)。液体复苏后再次行床旁超声、PiCCO测定上述数值,比较液体复苏前后IVC、RVI、LVEDV、ITBVI、EVLWI变化,并行相关性分析。结果液体复苏后超声测得IVCmax(1.69±0.31)cm、IVCmin(1.44±0.23)cm、LVEDV(122±41)ml较复苏前(1.24±0.23)cm、(0.65±0.18)cm、(106±34)ml增高,RVI(15.8±4.3)%较复苏前(46.9±6.5)%下降,与复苏前比较差异均有统计学意义(均P<0.05);IVC、LVEDV与ITBVI、EVLWI显著正相关(r=0.786、0.826、0.693、0.735、0.679、0.694、0.614、0.629、0.647、0.703、0.584、0.598,P均<0.01),RVI与ITBVI、EVLWI负相关(r=-0.635、-0.487、-0.527、-0.469,P均<0.05)。结论床旁超声监测感染性休克患者IVC、LVEDV可有效评估患者血容量,为临床液体复苏提供指导依据。

Objective To guided fluid resuscitation by monitoring the inferior vena cava diameter （IVC） and left ventricular end diastolic volume （LVEDV） with bedside ultrasound in patients with septic shock ,and to evaluate its clinical value .Methods Totally 112 elderly patients with septic shock were enrolled in this study .Inferior vena cava diameter （IVC） were measured by bedside ultrasound ,and inferior vena venous respiratory variation index （RVI） were calculated ,Left ventricular end diastolic volume （LVEDV ） were measured by bedside ultrasound before and after fluid resuscitation .Intrathoracic blood volume index （ITB‐VI） and extravascular lung water index （EVLWI） were got by pulse indicator continuous cardiac output （PiCCO） before and after fluid resuscitation .IVC ,RVI ,LVEDV and ITBVI ,EVLWI were compared be‐fore and after fluid resuscitation .Results IVCmax ,IVCmin and LVEDV were （1 .69 ± 0 .31）cm ,（1 .44 ± 0 .23）cm and （122 ± 41）ml after fluid resuscitation ,which were significantly higher than those[（1 .24 ± 0 .23）cm ,（0 .65 ± 0 .18）cm ,（106 ± 34）ml] before fluid resuscitation .RVI（15 .8 ± 4 .3）% decreased signifi‐cantly after fluid resuscitation （P〈0 .05） ;The IVC and LVEDV were positively correlated with ITBVI and EVLWI（r = 0 .786 ,0 .826 ,0 .693 ,0 .735 ,0 .679 ,0 .694 ,0 .614 ,0 .629 ,0 .647 ,0 .703 ,0 .584 ,0 .598 ,P〈0 .01） .RVI were negatively correlated with ITBVI and EVLWI （r = - 0 .635 ,- 0 .487 ,- 0 .527 ,- 0 .469 , P〈0 .05） .Conclusion The measurement of IVC and LVEDV by bedside ultrasound may be used as an al‐ternative method for fluid resuscitation in patients with septic shock .