无创血流动力学监测指导严重脓毒症患者血管活性药物的应用

Application of Impedance Cardiography in Patients with Severe Sepsis

目的:探讨无创血流动力学监测技术在严重脓毒症患者液体复苏后指导血管活性药物使用的意义。方法:选择2014年6月至2016年6月我院急诊处收治的严重脓毒症患者56例为研究对象,分为观察组和对照组,每组各28例。对照组进行常规对症治疗,观察组在对照组治疗基础上使用无创血流动力学监测仪指导治疗。观察两组患者在治疗前及治疗后6 h血流动力学及微循环灌注指标、液体复苏6 h后液体平衡量及血管活性药物使用量,及在重症监护病房(EICU)的入住时间。结果:治疗后两组患者尿量均大于30 m L/h,提示复苏成功。两组患者治疗后血液动力学指标和微循环灌注指标较治疗前均明显好转(均P<0.05);治疗后,两组间血液动力学指标和微循环灌注指标比较无明显差异(P>0.05)。观察组液体复苏6 h后液体平衡量明显少于对照组(P<0.05),观察组血管活性药物用量均明显高于对照组(P<0.05),观察组患者在EICU病房住院时间明显短于对照组(P<0.05)。结论:无创血流动力学监测对严重脓毒症患者的液体恢复管理和治疗过程具有指导意义,使血管活性药物得到有效利用,精确进行液体管理,减少盲目补液,缩短病程,减少患者的住院时间,经济高效,是指导治疗和评估治疗疗效的重要手段。

Objective： To investigate the significance of impedance cardiography in guiding the use of vasoactive drugs in patients with severe sepsis after fluid resuscitation. Methods： 56 cases of severe sepsis in the emergency department of our hospital from June 2014 to June 2016 were selected and divided into observation group and control group, 28 cases in each group. The control group was treated with routine therapy, and the observation group was treated with the guidance of noninvasive hemodynamic monitor on the basis of the control group. The hemodynamics and microcirculation perfusion index, amount of fluid balance and usage of vasoactive drugs at 6 h after fluid resuscitation, and stay time in EICU were observed and compared between the two groups before treatment and 6 h after treatment. Results： After treatment, the urine volume in two groups was more than 30 mL/h, suggesting successful resuscitation. After treatment, the hemodynamics and microcirculation perfusion indexes in two groups were significantly improved than before treatment （all P〈0.05）, but there was no significant difference between two groups after treatment （all P〉0.05）. The amount of fluid balance in the ob- servation group was significantly less than that of the control group （P〈0.05）, and the dosage ofvasoactive drugs in the observation group were significantly more than that of the control group （P〈0.05）, and the hospitalization time in the ICU significantly shorter in the obser- vation group than that of the control group （P〈0.05）. Conclusions： Invasive hemodynamic monitoring has clinical significance in the fluid recovery management and treatment process for the patients with severe sepsis, which can contribute to the effective utilization of vasoac- tive agents, and the accurate liquid management, decreasing the blind infusion, shortening the course of disease, and reducing hospitaliza- tion time and medical cost, so it is an important means to guide therapy and evaluate therapeutic effect.