无创心功能监测对高血糖高渗综合征补液的指导作用研究

Study on guiding effect of USCOM on hyperglycemia hypertonic syndrome

目的探讨无创心功能监测(USCOM)对重症监护病房(ICU)高血糖高渗综合征患者补液的指导作用。方法选择2016年3月1日至2018年3月1日该院收治的74例ICU高血糖高渗综合征患者为研究对象,根据血流动力学监测手段不同,采用随机数字表法分为USCOM组34例及中心静脉压监测组(CVP组)40例。观察2组患者入ICU后不同时间段的补液量、乳酸清除率、血浆渗透压及血糖达标时间、肺水肿或胸腔积液发生率、入住ICU时间及28 d死亡率。结果 2组患者入住ICU后3、6、12 h补液量,6、12、24 h乳酸清除率,血浆渗透压及血糖达标时间,28 d死亡率比较,差异均无统计学意义(P>0.05)。与CVP组比较,USCOM组在入住ICU(24、48 h)后补液量更少、肺水肿及胸腔积液发生率均较低、入住ICU时间缩短,差异均有统计学意义(P<0.05)。结论 USCOM指导ICU高血糖高渗综合征患者补液可减少补液量,降低肺水肿或胸腔积液发生率,缩短入住ICU时间,提高补液安全性。

Objective To investigate the guiding effect of ultrasonic cardiac output monitors （USCOM） on hyperglycemia hypertonic syndrome. Methods 74 patients with hyperglycemia hypertonic syndrome accepted hemodynamics moni- toring in the ICU admitted to the hospital fi＇om March 1,2016 to March 1,2018 were selected. According to hemodynamic moni- toring methods, used random number table, the patients were divided into two groups, 34 cases in USCOM group, 40 cases in central venous pressure monitors group （CVP group）. The volume of fluid input in different time, lactate clearance rate, time for plasma osmotic pressure and blood glucose return to normal, puhnonary edema or pleural effusion occmTence rate, length of ICU stay and 28 days mortality of two group were observed. Results The volume of fluid input of 3,6,12 h, the lactate clea- rance rate of 6,12,24 h, time for plasma osmotic pressure and blood glucose return to normal, 28 days mortality in two groups were no statistical difference （P〉0.05）. Compared with CVP group, the volume of fluid input of 24,48 h, the puhnonary edema or pleural effusion occurrence rate and length of ICU stay in USCOM group were decreased, the differences were statistically significant （P〈0.05）. Conclusion The hyperglycemia hypertonic syndrome patients accepted USCOM in fluid itffusion are safer because of lesser volume of fluid input, lower puhnonary edema or pleural effusion occurrence rate and shorter length of ICU stay.