早期运用液体平衡策略对改善心源性休克循环灌注的意义

Significance of early fluid balance strategy in improving circulatory perfusion of cardiogenic shock

目的:探讨早期运用液体平衡策略对改善心源性休克循环灌注的意义。方法:选择2015年5月至2018年5月收治的心源性休克患者作为研究对象,共80例,根据液体复苏达标时间进行分组,所有患者均给予采用限制性补液的个体化治疗策略,以入院后6 h内液体复苏后实现中心静脉压>8 mmHg且中心静脉血氧饱和度>70%者为早期液体复苏达标,即体液平衡早期达标组为观察组;入院后3 d内至少1 d达限制性液体管理达标者为体液平衡晚期达标组,即对照组;比较两组患者治疗前治疗后心功能指标、肺功能指标、血气指标。结果:观察组患者治疗后心功能指标优于对照组(P<0.05),肺功能指标优于对照组(P<0.05),血氧分压高于对照组(P<0.05),血二氧化碳分压低于对照组(P<0.05);两组患者治疗后心功能优于治疗前(P<0.05),肺功能指标优于治疗前(P<0.05)。结论:早期运用液体平衡策略对改善心源性休克循环灌注效果满意,可以有效改善患者的心肺功能和血气指标,比晚期运用液体平衡策略更具疗效。

Objective:To explore the significance of early fluid balance strategy in improving circulatory perfusion of cardiogenic shock. Methods:80 patients with cardiogenic shock hospitalized from May 2015 to May 2018 were selected as the study subjects. They were grouped according to the time of reaching the standard of fluid resuscitation. All patients were given the individualized treatment strategy of "limited fluid resuscitation". The patients with central venous pressure >8 mm Hg and central venous oxygen saturation >70 % within 6 hours after fluid resuscitation whose resuscitation reached the standard in the early stage of body fluid balance were chosen as the observation group, and those whose late stage of body fluid balance reached the limit of fluid management at least one day after admission were chosen as the control group. The indexes of cardiac function, pulmonary function and blood gas were compared between the two groups before and after treatment. Results:After treatment, the indexes of cardiac function in the observation group were significantly better than those in the control group(P<0.05), the indexes of pulmonary function were significantly better than those in the control group(P<0.05), and the partial pressure of oxygen in blood was significantly higher than that in the control group(P<0.05), and the partial pressure of carbon dioxide in blood was significantly lower than that in the control group(P<0.05);after treatment, the cardiac function in the two groups was significantly better than that before treatment, and the indexes of pulmonary function were significantly better than that before treatment. Conclusion:Early use of liquid balance strategy can improve the circulatory perfusion of cardiogenic shock satisfactorily, and can effectively improve the cardiopulmonary function and blood gas indexes of patients, which is more effective than late use of liquid balance strategy.