重症超声联合Pcv-aCO_2指导感染性休克液体复苏的研究

Study on Severe Ultrasound Combined With Pcv-a CO_2 GuidedLiquid Resuscitation in Septic Shock

目的研究重症超声联合中心静脉血与动脉血二氧化碳分压差(Pcv-a CO_2)在指导感染性休克患者液体复苏过程中的应用效果。方法选取我院重症医学科2014年1月—2016年12月收住的感染性休克患者126例为研究对象,按照随机数字分组法,将其分为研究组和对照组。对照组(63例)采用中心静脉血与动脉血二氧化碳分压差进行监测,并根据监测数据指导液体复苏;研究组(63例)在对照组监测方法基础上,联合重症超声进行监测,依据研究组监测数据进行评估后再予液体滴定复苏。同时两组患者均给予呼吸机通气、抗生素治疗、血管活性药物维持血压等对症支持治疗。观察两组患者机械通气时间、ICU住院时间、28 d病死率、6 h平均入液量、早期目标治疗(EGDT)、肺水肿发生率、血管活性药物用量。结果研究组机械通气时间、ICU住院时间及28 d病死率均低于对照组,6 h平均入液量少于对照组;研究组去甲肾上腺素及多巴酚丁胺用量均低于对照组,研究组肺水肿发生率低于对照组,组间数据对比,差异均具有统计学意义(P<0.05)。结论重症超声联合中心静脉血与动脉血二氧化碳分压差在指导感染性休克液体复苏过程中相比单纯使用中心静脉血与动脉血二氧化碳分压差更有优势。

Objective To study the difference in ultrasound combined with central venous blood and arterial blood carbon dioxide （Pcv-aCO2） application in the guidance of patients with septic shock during fluid resuscitation. Methods A total of 126 patients enrolled in the Department of Severe Medicine from January 2014 to December 2016 were selected as the study objects. They were divided into study group and control group according to the random number grouping method. The control group （63 cases） was treated with central venous blood and arterial blood carbon dioxide partial pressure difference, and the fluid resuscitation was instructed according to the monitoring data. The study group （63 cases）, on the basis of the control group, was monitored on the basis of the monitoring method. According to the research group monitoring data, it was to assess the liquid titration after the recovery. The mechanical ventilation time, ICU hospitalization time, 28 d mortality rate, average infusion volume of 6 h, early target therapy （EGDT）, incidence of pulmonary edema and the dosage of vasoactive drugs were observed in two groups. Results The mechanical ventilation time, ICU hospital stay and 28 d mortality and norepinephrine and dobutamine were significantly lower in the study group than in the control group. The average liquid intake of 6 h was less than that of the control group. The average infusion late and pulmonary edema were lower than those in the control group, the difference between the two groups was statistically significant （P 〈 0.05）. Conclusion Severe ultrasound combined with central venous blood pressure and arterial CO2 partial pressure difference is more advantageous in guiding the resuscitation of septic shock than the use of cenwal venous 101ood and arterial CO2 partial pressure difference.