湘雅医院2个ICU重症患者液体治疗现状调查

A survey of fluid therapy in 2 intensive care units

解患者在ICU治疗期间液体治疗现状,及液体治疗与预后的相关性.记录所有纳入本研究患者的液体治疗情况,包括入ICU后连续7d的液体治疗量[24h总入量、24h总出量、24h液体净平衡量（24h总入量-24h总出量）],液体种类（晶体液、胶体液、血液制品）;液体治疗目的包括容量治疗（液体复苏）、维持输液（维持液体管路通畅）、治疗用药（抗感染、保肝等治疗配液）、营养治疗用液（含肠内与肠外营养）.同时记录患者肝肾功能、机械通气时间、住ICU时间、住院时间、住院死亡情况,并进行相关性分析.结果显示,患者液体入量在入ICU第5天[2806（1997,3582）ml]达高峰.液体净平衡在第4天开始实现负平衡-84（-1127,612）ml,且随住ICU时间呈逐步增多趋势.治疗用药和营养液量在整个治疗液体中占比较大.液体总入量、晶体总入量、胶体总入量与患者住院时间、住ICU时间、机械通气时间均存在正相关（r值分别为0.211、0.686、0.282、0.155、0.506、0.174、0.209、0.072、0.292,P＜0.05）,胶体总入量与总胆红素、直接胆红素、丙氨酸转氨酶、天冬氨酸转氨酶、尿素氮、肌酐存在正相关（r值分别为0.196、0.242、0.190、0.335、0.284、0.223,P＜0.05）.

To explore the present status of fluid therapy and clinical outcome in critically ill patients in intensive care units （ICU）.ICU patients consecutively admitted to our ICU were prospectively enrolled.Patients＇ demographics,laboratory data,fluid record and clinical outcome were collected.Fluid intake quantity of all patients was at peak on the fifth day which was 2 806 （1 997,3 582）ml.From the fourth day in ICU,fluid balance started to benegative as-84 （-1 127,612）ml and gradually increased.Crystalloid solution was the main components.For treatment purposes,medication injections and nutrients were major fluids.Positive correlations were found between total fluid intake quantity,total crystalloid volume,total colloidal volume and hospital stay,ICU stay,duration of intubation （r values as 0.211,0.686,0.282,0.155,0.506,0.174,0.209,0.072,0.292,respectively P〈0.05）.Moreover,positive correlations were also demonstrated between total colloidal volume and total bilirubin,direct bilirubin,alanine transaminase,aspartate transaminase,blood urea nitrogen,serum creatinine （r values as 0.196,0.242,0.190,0.335,0.284,0.223,respectively P〈0.05）.