不同液体复苏策略对脓毒性休克患者呼吸力学及氧合的影响

Effect of different fluid resuscitation strategies on respiratory mechanics and oxygenation in patients with septic shock

目的观察不同液体复苏策略对脓毒性休克患者呼吸力学及氧合的影响。方法回顾性调查分析该院重症医学科(ICU)125例脓毒性休克患者72h的救治资料,根据液体复苏结果分成限制性液体复苏组(n=58)和开放性液体复苏组(n=67),比较两组复苏前后的呼吸力学(静态肺顺应性、吸气阻力)及氧合的变化,同时记录两组血流动力学及血管活性药物应用情况。结果两组患者血流动力学指标差异无统计学意义(P>0.05),开放性液体复苏组的血管活性药物用量及时长均较限制性液体复苏组少或短(P<0.01);两组的气道阻力复苏前、后无明显变化,复苏后限制性液体复苏组的肺顺应性及氧合均优于开放性液体复苏组(P<0.01)。随着液体复苏量的增加,无论是限制性液体复苏组还是开放性液体复苏组,肺的顺应性均进行性变差,尤其是在开放性液体复苏组患者更为明显(P<0.01);液体复苏的量与肺顺应性及氧合呈负相关(R=-0.783、-0.860,P<0.01)。结论脓毒性休克救治时,开放性复苏策略虽然血管活性药物用量少、时长短,但是肺的顺应性及氧合均受影响,而限制液体复苏策略则相反。

Objective To observe the effect of different fluid resuscitation strategies on respiratory mechanics and oxygenation in the patients with septic shock.Methods The treatment data in 125 patients with septic shock in ICU of this hospital were retrospectively investigated and analyzed.The patients were divided into the restriction fluid resuscitation group（n=58）and open fluid resuscitation（n=67）according to fluid resuscitation results.The changes of respiratory mechanics（static lung compliance,inspiratory resistance）and oxygenation before and after resuscitation were compared between the two groups.Meanwhile the hemodynamics and vasoactive drugs application were recorded in the two groups.Results The hemodynamic indicators had no statistical difference between the two groups.The use amounts and use time of vasoactive drugs in the open fluid resuscitation group were less than those in the restriction fluid resuscitation group（P〈0.01）;the airway resistance in the two groups had no obvious change between before and after resuscitation,the lung compliance and oxygenation in the restriction fluid resuscitation group were superior to those in the open fluid resuscitation group（P〈0.01）.With the fluid resuscitation amount increase,the lung compliance in the restriction fluid resuscitation group and open fluid resuscitation group were progressively poorer,which was especially obvious in the open fluid resuscitation group（P〈0.01）;the amount of fluid resuscitation was negatively correlated with the lung compliance and oxygenation（R=-0.783、-0.860,P〈0.01）.Conclusion In treating septic shock,although the open resuscitation strategy has smaller dose and use time of vasoactive drugs,but the lung compliance and oxygenation are affected,while the restriction fluid resuscitation strategy is in contrast.