早期颈外静脉通路对脓毒症患者液体复苏及预后的影响

The effect of early external jugular vein access for fluid resuscitation on prognosis of sepsis patients

目的：探讨早期颈外静脉通路对脓毒症患者液体复苏效果及预后的影响。方法：将入住我院急诊及重症监护室治疗的脓毒症患者120例，随机分为颈外静脉组和深静脉组（颈内静脉、锁骨下静脉、股静脉），每组60例，记录入科到去甲肾上腺素使用之间的时间、血管活性药物使用时间（多巴胺、去甲肾上腺素、多巴酚丁胺）、早期目标导向治疗（Early Goal Directed Therapy, EGDT）达标时间，3、6小时乳酸水平、乳酸清除率及序贯器官衰竭评分（Sequential Organ Failure Assessment, SOFA），比较两组14、28天死亡率。结果：与深静脉组相比，颈外静脉组入科后使用去甲肾上腺素时间、EGDT达标时间均明显缩短[（20．78±5．03）w．（6．12±2．58），P〈0．01；（6．15±2．03）VS．（5．35±2．21），P〈0．05]，3h乳酸水平明显降低[（6．88±1．71）VS．（6．28±1．51），P〈0．05]，3h乳酸清除率（％）显著增加[（25．8±9．2）w．（31．2±13．3），P〈0．05]，6hSOFA评分显著下降[（5．78±1．19）W．（5．38±0．96），P〈0．05]，14d病死率明显下降（33．3％坩．16．7％，P〈0．05）。结论早期颈外静脉通路更有利于节约时间，有效提高脓毒症患者液体复苏的效果，促进脏器功能恢复，有利于改善预后。

Objective To evaluate the effect of fluid resuscitation with early external jugular vein access on prognosis of sepsis patients. Methods One hundred and twenty patients with sepsis, admitted to emergency intensive care unit （EICU） and the general intensive care units （ICU） were randomly divided into two groups, external jugular vein group （n=60） and deep-vein group （e.g. internal jugular vein, subclavian vein, femoral vein, n=60）. The time elapsed from admission to initial application of norepinephrine, the time required for getting the early goal directed therapy （EGDT） after standard procedure, the length of time needed for subsequent use of vasoactive agents during the entire course of resuscitation serum lactate level at3 h and 6 h after resuscitation, lactate clearance rate, SOFA scores were documented. The mortality rates of 14 days and 28 days were observed after treatment. Results Compared with deep vein access, the time elapsed from admission to the initial application of norepinephrine and the time required for getting EGDT were significantly shortened [ （20.78±5.03） vs.（6.12±2.58）, P〈0.01 ;（6.15±2.03）vs.（5.35±2.21）, P〈0.05], and the serum level of lactate was significantly decreased[（6.88±1.71）vs.（6.28±1.51）, P〈0.05] at 3 h after resuscitation, and lactate clearance rate in percentage was significantly increased at 3 h after resuscitation, and SOFA at 6 h was decreased[ （25.8±9.2） vs.（31.2±13.3）, P〈0.05], and SOFA at 6 h was distinctly reduced [（5.78±1.19） vs. （5.38±0.96）, P〈0.05],and. the mortality rates of 14 days decreased significantly in the external jugular vein group（33.3% vs. 16.7%, P〈0.05）. Conclusions Early external jugular vein access can more significantly save time, improve the effect of fluid resuscitation, promote recovery of important organ. It is helpful for improving prognosis in sepsis patients.