“扩容临界点”在脓毒性休克患者液体复苏中的指导意义——附一例报告

A case report with discussion and exploration on a critical point in fluid resuscitation in septic shock patients

为探讨在缺乏有创性监测手段的情况下,通过记录、分析脓毒性休克患者各项基础生命体征数据的动态变化,是否可预判患者的"扩容临界点",指导临床液体复苏方案,笔者对临床上脓毒性休克患者的生命体征数据进行回顾性整理分析,结合血流动力学、组织氧合、脏器功能、影像学结果等指标来判断"扩容临界点"。结果显示脓毒性休克患者的容量状态与生命体征数据变化存在显著相关性,可以通过分析生命体征数据结合血流动力学、组织氧合指标来判断"扩容临界点"。可见"扩容临界点"在脓毒性休克患者液体复苏中具有一定指导意义,但也需要更多的证据来支持。

Objective To explore a critical point in fluid resuscitation in septic shock patients,based on dynamic change of vital signs, lab results, clinical examinations when invasive monitoring was lacking. Methods The data of patients＇ vital signs were analyzed retrospectively, and a critical point in fluid resuscitation based on hemodynamic parameters, tissue oxygenation, multiple organ function and radiographic results was explored. Results There was a significant correlation between fluid resuscitation capacity and vital signs in patients with septic shock. A critical point in fluid resuscitation could be found by analyzing vital signs combined with hemodynamic parameters and tissue oxygenation. Conclusion A critical point in fluid resuscitation can be helpful in fluid resuscitation in patients with septic shock, although further investigation is necessary.