脓毒症患者早期液体复苏后液体管理研究

Study on fluid management in patients with sepsis after early fluid resuscitation

目的为有效对早期液体复苏后的脓毒症患者实施液体管理,探究不同液体管理方式对患者疾病治疗的影响。方法本次研究对象为我院2014年6月~2016年6月期间诊断为脓毒症的42例患者,临床分组采用随机数字表法将患者分为常规、治疗两组,每组均为21例。所有患者在早期液体复苏后,常规组给予二级液体管理,治疗组根据中心静脉压、每小时尿量、BE、SCVO2给予液体管理,对比两组患者重症监护时间、药物使用时间、通气辅助时间、气管插管发生率,统计临床病死率,比较液体管理后两组患者心率、呼吸频率变化。结果常规组气管插管率、死亡发生率为47.6%、14.3%,明显高于治疗组23.8%、4.8%,治疗组患者死亡率低、气管插管发生少,差异有统计学意义(P<0.05);治疗组较常规组ICU费用低、机械通气时间短、重症监护时间少,差异有统计学意义(P<0.05);治疗组患者心率、呼吸频率恢复均优于常规组,差异有统计学意义(P<0.05)。结论脓毒症患者在早期液体复苏后以中心静脉压、每小时尿量、BE、SCVO2监测来指导液体使用量,患者恢复快、住院时间少。

Objective To effectively manage fluid resuscitation in patients with early fluid resuscitation,and toexplore the treatment of patients with different fluid management.Methods42patients with sepsis diagnosed in ourhospital from June2014to June2016were selected as the study object.They were divided into two groups accordingto the random number table with21cases in each.All patients were treated with early fluid resuscitation.Patientsin routine group were given two level liquid management.Patients in treatment group were treated with manage fluidadministration according to central venous pressure,hourly urine volume,BE,and SCVO2.The time of intensive care,the time of drug use,the time of ventilatory assistance and the rate of tracheal intubation,and the clinical fatalityrate,and the changes of heart rate and respiratory rate in the two groups after liquid administration were compared.Results The trachea intubation rate and the mortality rate of the conventional group were47.6%and14.3%,which were significantly higher than those of the treatment group with23.8%and4.8%,and the mortality rate of thetreatment group was lower and the trachea intubation was less(P<0.05).Compared with the conventional group,thetreatment group had lower ICU cost,shorter mechanical ventilation time,and less intensive care time,the differencewas statistically significant.The recovery rate of heart rate and respiratory rate in the treatment group was better thanthat in the routine group(P<0.05).Conclusion For patients with sepsis after early resuscitation,the method ofcentral venous pressure,urine volume per hour,BE and SCVO2monitoring to guide the use of fluids has good effect.The patients recoveres quickly,and has less hospital stay.