无创血流动力学监测在老年感染性休克患者早期液体复苏中的应用

Application of noninvasive hemodynamic monitoring in early fluid resuscitation of elderly patients with septic shock

目的探讨连续无创血流动力学监测联合去甲肾上腺素治疗在老年感染性休克患者早期液体复苏中的应用。方法选择2016年3月-2017年9月遵义市第一人民医院收治的老年感染性休克患者38例,所有患者均接受去甲肾上腺素治疗联合连续无创血流动力学监测,分别在治疗前、治疗6 h后及治疗12 h后对患者灌注水平及氧代谢改善情况进行检测观察,分析连续无创血流动力学监测联合去甲肾上腺素治疗对灌注水平、氧代谢及血流动力学的影响。结果治疗后,患者心率(heart rate,HR)水平低于治疗前;平均动脉压(mean arterial pressure, MAP)、心输出量(cardiac output, CO)和心输出量指数(cardiac index, CI)均高于治疗前;随治疗时间延长,患者HR水平降低明显,MAP、CO及CI水平升高明显,治疗后12 h相关指标与治疗后6 h比较,差异有统计学意义(P<0.05)。治疗后,患者氧输送(oxygen delivery DO2)、中心静脉血氧饱和度(systemic central venous oxygen saturation, ScvO2)高于治疗前;乳酸(lactate, Lac)水平低于治疗前;治疗12 h后的Lac清除率高于治疗6 h后(P<0.05)。患者平均住院天数为(14.61±6.05)d;治疗期间出现脑水肿1例、肺水肿1例、心率衰竭1例,并发症发生率为7.89%,多器官功能障碍(multiple organ dysfunction syndrome, MODS)发生率为23.68%(9/38)。结论连续无创血流动力学监测联合去甲肾上腺素治疗老年感染性休克患者,可有效提高患者灌注水平、改善氧代谢及血流动力学。

OBJECTIVE To explore the application of continuous noninvasive hemodynamic monitoring combined with norepinephrine in treatment of elderly patients with septic shock. METHODS A total of 38 elderly patients with septic shock who were treated in the First People′s Hospital of Zunyi from Mar 2016 to Sep 2017 were enrolled in the study, all of the patients were treated with the norepinephrine combined with continuous noninvasive hemodynamic monitoring.The level of perfusion and improvement of oxygen metabolism of the patients were observed before the treatment and after the treatment for 6 and 12 hours, and the effects of the continuous noninvasive hemodynamic monitoring combined with norepinephrine on the level of perfusion, oxygen metabolism and hemodynamics were observed. RESULTS The heart rate(HR) of the patients was lower after the treatment than before the treatment;the mean arterial pressure(MAP), cardiac output(CO) and cardiac index(CI) of the patients were higher after the treatment than before the treatment.With the extension of time, the HR of the patients was declined, while the MAP, CO and CI were elevated, and there were significant differences in the related indexes after the treatment for 12 hours and after the treatment for 6 hours(P<0.05).The oxygen delivery(DO2) and systemic central venous oxygen saturation(ScvO2) of the patients were significantly higher after the treatment than before the treatment;while the lactate(Lac) level of the patients was significantly lower after the treatment than before the treatment, the clearance rate of Lac was significantly higher after the treatment for 12 hours than after the treatment for 6 hours(P<0.05).The average length of hospital stay of the patients was(14.61±6.05) days.There were 1 case of cerebral edema, 1 case of pulmonary edema and 1 case of heart failure during the treatment, the incidence of complications was 7.89%, and the incidence of multiple organ dysfunction syndrome(MODS) was 23.68%(9/38). CONCLUSION As used for the treatment of the elderly patients with septic shock, the continuous noninvasive hemodynamic monitoring combined with norepinephrine may effectively raise the perfusion level and improve the oxygen metabolism as well as the dynamics.