每博量变异、血管外肺水指数在烧伤机械通气患者液体复苏临床指导意义

Clinical Significance of Stroke Volume Variation and Extravascular Lung Water Index in Fluid Resuscitation for Burn Patients with Mechanical Ventilation

目的探讨每博量变异(SVV)、血管外肺水指数(EVLWI)在烧伤机械通气患者液体复苏中的临床指导意义。方法选取2015年3月~2017年3月我院收治的68例大面积烧伤急诊气管切开机械通气患者。按其是否采用PiCCO监测分为治疗组30例和对照组38例。其中观察组依据患者有创血压、每博量变异(SVV)、血管外肺水指数(EVLWI)、心率、每小时尿量等监测指标指导液体复苏;对照组依据有创动脉压、中心静脉压(CVP)、心率、每小时尿量等监测指标指导液体复苏;观察两组患者休克期内各个时间点(6h、12h、24h、36h、48h)血流动力学指标、血气分析指标、休克期第1个24h、第2个24h补液总量;两组患者入院72h后肺水肿、胸腔积液发生率。结果观察组第1个24h、第2个24h液体补充总量与对照组比较,差异显著(P<0.05);观察组入院72h后肺水肿发生率显著少于对照组,差异有统计学意义(P<0.05)。结论每博变异、血管外肺水指数可有效监测烧伤机械通气患者休克期液体复苏过程中心脏及机体液体负荷情况,减少因机械通气液体复苏时胸腔内压对CVP的影响,保证各个脏器有效灌注,减轻肺水肿的发生率。

Objeaive To investigate the clinical significance of stroke volume variation （SVV） and extravascular lung water index （EVLWI） in fluid resuscitation of burn patients with mechanical ventilation.Methods The data of fluid resuscitation of 68 patients with extensive severe burn with the emergency tracheotomy during the shock period,in burn department of Zhengzhou first people＇s Hospital from 2015 March to 2017 March,were analyzed retrospectively.ccording to whether the use of PiCCO monitoring,68 patients was divided into PiCCO treatment group （30 cases）and non- PiCCO group （38 cases）.The PiCCO group according to the patient＇s blood pressure, stroke volume variation（SVV）,extravascular lung water index（EVLWI）,heart rate, urine volume as per hour monitor- ing indicator of fluid resuscitation; non PICCO treatment group on the basis of arterial blood pressure, central venous pressure（CVP）,heart rate, urine volume as per hour monitoring indicator of fluid resuscitation;observation the time point of two groups of patients shock stage（6h,12h,24h, 36h, 48h） hemodynamies, blood gas analysis index（oxygenation index, blood lactic acid）,incidence of the 72h pulmonary edema, pleural effusion the statistics of the two groups of patients （according to CT, chest ultrasound results）.Results PiCCO group with mechanical ventilation in the first 24h, the second 24h of the total liquid has significant difference with non-PiCCO treatment group （P〈 0.05）, PiCCO treatment group was less than the amount of non-PiCCO infusion treatment group 72h after admission; pulmonary edema the incidence rate of PiCCO, the PiCCO group is less than non-PiCCO group two was statistically difference （P〈0.05）.Conclusion SVV, EVLWI monitoring of mechanical ventilation in burn shock resuscitation process,reduce the intrathoracic pressure effect on CVP mechanical ventilation and fluid resuscitation,ensure the effective organ perfusion,reduce the incidence of pulmonary edema.