基于每搏量变异度的液体复苏策略对脓毒性休克患者的疗效评价

Effect of fluid resuscitation strategy based on stroke volume variation for patients with septic shock

目的探讨每搏量变异度(SVV)指导下的液体复苏策略对脓毒性休克患者的疗效及预后的影响。方法将62例脓毒性休克患者随机分为SVV组和对照组,各31例。所有患者均给予脓毒性休克的常规对症治疗,SVV组和对照组分别采用SVV、中心静脉压(CVP)指导下液体复苏治疗。比较两组复苏前后血流动力学指标的变化,疗效及预后情况。结果两组患者CVP、MAP、CI、ELWI、PaO2/FiO2均随着时间推移出现不同程度的改善,SVV组复苏后6h、24h后MAP较对照组明显降低,ELWI、PaO2/FiO2显著升高(P<0.05)。与对照组比较,SVV组机械通气(MV)时间、ICU住院时间均明显缩短,24h血管活性药物使用量及输液量均明显减少(P<0.05)。SVV组急性心功能不全的发生率为6.45%,显著低于对照组32.26%(P<0.05)。结论基于SVV的液体复苏策略较CVP更为安全有效,有助于优化液体管理,维持血流动力学稳定,改善脓毒性休克患者的预后。

Objective To explore the effect of fluid resuscitation strategy based on stroke volume variation(SVV)for patients with septic shock.Methods 62 patients with septic shock were randomly divided into the SVV group(n=31)and the control group(n=31).All patients were given conventional treatment of septic shock,and the SVV group and the control group were given fluid resuscitation therapy under the guidance of SVV and central venous pressure(CVP),respectively.The change of hemodynamic parameters before and after resuscitation,curative effect and prognosis between the two groups were compared.Results The levels of CVP,MAP,CI,ELWI,PaO 2/FiO 2 in both groups were improved.Compared with the control group,the levels of MAP at 6th,24th hour after resuscitation in the SVV group decreased,and ELWI and PaO 2/FiO 2 increased(P<0.05).Compared with the control group,the mechanical ventilation time and duration of ICU stay in the SVV group were significantly shortened,and 24-h vascular active drug usage and transfusion volume were significantly reduced(P<0.05).The incidence of acute cardiac insufficiency in the SVV group was 6.45%,which was significantly lower than 32.26%in the control group(P<0.05).Conclusion Fluid resuscitation strategy based on SVV is more effective and safe than CVP,which is helpful to optimize fluid management,maintain hemodynamic stability,and improve the prognosis of patients with septic shock.