心功能不全并脓毒性休克患者液体复苏中全心舒张末期容积指数的应用价值

Analysis of application value of global end-diastolic volume index in fluid resuscitation in patients with cardiac insufficiency and septic shock

目的探讨全心舒张末期容积指数(GEDI)在心功能不全并脓毒性休克患者液体复苏中的作用及应用价值。方法选择2016年6月—2018年6月本院重症医学科(ICU)收治的52例心功能不全并脓毒性休克患者作为研究对象,随机分为常规组和脉搏指示持续心输出量组(PICCO组),每组各26例。常规组按照脓毒症指南进行常规早期目标导向治疗;PICCO组根据GEDI进行液体复苏,维持GEDI在680~800 mL/m^2。观察比较两组患者达标所需液体总量、24 h血管外肺水指数(EVLWI)、脑尿钠肽(BNP)、去甲肾上腺素(NE)用量及0 h、6 h、24 h乳酸值及乳酸清除率。结果与常规组患者相比,PICCO组患者达到复苏目标所需液体总量、24 h EVLWI、BNP均明显降低,差异均具有统计学意义(P<0.05)。与PICCO组相比,常规组患者NE用量明显更高,差异有统计学意义(P<0.05)。常规组与PICCO组患者0 h乳酸值差异无统计学意义(P>0.05);与常规组相比,PICCO组患者6 h、24 h乳酸值明显降低,而乳酸清除率明显升高,差异均具有统计学意义(P<0.05)。结论心功能不全患者合并脓毒性休克时,以PICCO下GEDI为指导进行液体复苏所需液体较少,肺水肿及心功能损伤较轻,是临床较为可靠的液体复苏指导指标。

Objective To study the role and application value of global end-diastolic volume index(GEDI)in fluid resuscitation in patients with cardiac insufficiency and septic shock.Methods 52 patients with cardiac dysfunction and septic shock,those hospitalized in ICU in our hospital from June 2016 to June 2018,were randomly divided into the routine group and the pulse-directed continuous cardiac output(PICCO)group.Patients in routine group received early target-directed therapy according to guideline for sepsis.Patients in PICCO group received fluid resuscitation according to the global end-diastolic volume index,maintaining GEDI at 680-800 mL/m^2.Total amount of fluid required for the two groups of patients,24 h extra-vascular lung water index(EVLWI),brain natriuretic peptide(BNP),norepinephrine(NE)dosage,0 h,6 h,24 h lactate value and lactate clearance rate of the two groups were observed and compared.Results Compared with the conventional group,the total amount of fluid required for the recovery target,24 h EVLWI,and BNP were significantly lower in the PICCO group,and the difference was statistically significant(P<0.05).Compared with the PICCO group,the NE dose in the conventional group was significantly higher,and the difference was statistically significant(P<0.05).There was no significant difference in 0 h lactic acid value between the conventional group and the PICCO group(P>0.05).Compared with the conventional group,the lactic acid value of the PICCO group was significantly decreased at 6 h and 24 h,and the lactate clearance rate was significantly increased,and the difference was statistically significant(P<0.05).Conclusions For patients with cardiac insufficiency combined with septic shock,less fluid required for fluid resuscitation guided by GEDI under PICCO,with less pulmonary edema and less cardiac function damage,it is clinically reliable targets for fluid resuscitation.