床边心脏彩超在老年脓毒症休克补液治疗中的应用

Application of cardiac color doppler ultrasound in the treatment of senile sepsis with shock fluid replacement

目的探讨床边心脏彩超在老年脓毒症休克患者的补液治疗过程中监测的意义。方法本研究通过前瞻性研究,选择入住本院重症监护室(ICU)及急诊重症监护病房(EICU)的诊断为脓毒休克患者74例。所有患者入院时及治疗24h后均做心脏彩超检查,评估左心功能。并将患者随机分成两组,监测组和未监测组。监测组:入院治疗后每6小时行心脏彩超检查,测定左心室射血分数,共38人。未监测组:入院后到治疗24h之间未对患者行心脏彩超检查,共36人。两组患者入院后均给予心电监护、深静脉置管、抗感染、液体疗法、去甲肾上腺素等升压药应用,改善微循环、营养支持,必要时行气管插管、呼吸机辅助通气等治疗。观察乳酸(Lac)水平、钠尿肽(BNP)、中心静脉压(CVP)。并对监测组患者入院后每隔6h重复行心脏彩超检查,观察各组病例心脏运动及血流情况,并测量左心室射血分数(LVEF)。结果治疗24h复查的指标中,未监测组的左室射血分数低于监测组,差异有统计学意义(t=9.637,P=0.000);两组间的中心静脉压差异无统计学意义(t=-0.944,P=0.348);未监测组的钠尿肽高于监测组,差异有统计学意义(t=-2.551,P=0.014);未监测组的乳酸水平高于监测组,差异有统计学意义(t=-2.295,P=0.025);未监测组的平均动脉压低于监测组,差异有统计学意义(t=2.346,P=0.022)。结论在脓毒症休克补液期间反复使用床边心脏彩超监测能很好的观测患者心功能波动情况,为继续补液及使用升压强心药物改善重要器官东灌注提供了很好的帮助。

Objective To explore the significance of cardiac color doppler ultrasound in the course of rehydration therapy for senile patients with sepsis shock and its influence on clinical diagnosis and treatment decision. Methods In this study, 74 patients with septic shock were selected to be admitted to the intensive care unit (ICU) and the emergency intensive care unit (EICU) of our hospital through prospective study. All patients underwent cardiac color ultrasonography at the time of admission and 24 hours after treatment to assess left cardiac function. Patients were randomly divided into two groups, the monitoring group and the unmonitored group. Monitoring group: heart color ultrasonography was performed every 6 hours after admission and left ventricular ejection fraction was measured for 38 patients.Unmonitored group: 36 patients were not examined for cardiac color ultrasound between admission and 24 hours of treatment. After admission, both groups of patients were given cardiac monitoring, deep vein catheterization, anti-infection, liquid therapy, norepinephrine and other applications of booster drugs to improve microcirculation and nutritional support, and if necessary, tracheal intubation and ventilator assisted ventilation.Lactate level, natriuretic peptide (BNP) and central venous pressure (CVP) were observed. The patients in the monitoring group were repeated every 6 hours after admission to the hospital for cardiac color ultrasonography, cardiac movement and blood flow were observed in each group, and the left ventricular ejection fraction (LVEF) was measured. Results The left ventricular ejection fraction of the unmonitored group was lower than that of the monitored group (t=9.637, P=0.000). There was no significant difference in central venous pressure between the two groups (t=-0.944, P=0.348). The natriuretic peptide in the unmonitored group was higher than that in the monitored group, and the difference was statistically significant (t=-2.551, P=0.014). The lactic acid level of the unmonitored group was higher than that of the monitored group, and the difference was statistically significant (t=-2.295, P=0.025). The mean arterial pressure of the unmonitored group was lower than that of the monitored group, and the difference was statistically significant (t=2.346, P=0.022). Conclusion In sepsis shock during rehydration repeated use of bedside monitoring can be a very good heart colour to exceed volatility observed in patients with cardiac function, to continue to use a booster rehydration and cardiac drugs improve vital organ perfusion east provides a good help.