最适宜下腔静脉宽度指导脓毒症休克患者个体化液体管理的应用价值

Application value of optimal width of inferior vena cava to guide individualized fluid management in patients with septic shock

研究在床旁超声动态监测下腔静脉,采用最适宜下腔静脉宽度概念指导个体化液体治疗策略与ICU常规液体治疗策略相比较,是否可改善脓毒症休克患者的预后。收集入住安徽省立医院重症医学科的脓毒症休克患者,采用简单随机化方法将患者分为两组,对照组采用常规治疗策略处理,干预组以个体化液体管理策略处理,比较两组患者的出入量以及预后。两组患者的性别、年龄、基础疾病、感染部位、APACHE II评分、SOFA评分、机械通气比例的差异均无统计学意义(P>0.05)。干预组的前3 d和前5 d的液体累计入量、液体净平衡量、ICU死亡率、相关并发症如急性心力衰竭及低氧血症的发生率均低于对照组(P<0.05)。采用最适宜下腔静脉宽度概念指导的个体化液体治疗方案,可以减少患者入量,降低发生液体超负荷相关并发症的风险,改善患者预后。

In research of dynamic monitoring of the inferior vena cava by bedside ultrasound and using the concept of optimal inferior vena cava width to guide individualized liquid therapy strategies that compared with conventional ICU fluid therapy strategies, it is studied whether it can improve the prognosis of patients with septic shock. Patients with septic shock from the Department of Critical Care Medicine of Anhui Provincial Hospital were admitted to the study. They were randomly divided into two groups by simple randomization method. The control group was treated with conventional treatment strategy while the intervention group was treated with individualized liquid management strategy.The volume and the prognosis of patients in the two groups were contrasted. There was no significant difference in gender, age, underlying disease, infection site, APACHE II score, SOFA score, and mechanical ventilation ratio between the two groups(P>0.05). The cumulative fluid intake, net fluid balance, ICU mortality and the frequency of related complications such as acute heart failure and hypoxemia in the first three and five days of the intervention group were lower than those in the control group(P<0.05).The use of an individualized liquid treatment guided by the concept of the optimal width of inferior vena cava can reduce patients’ intake, reduce the risk of complications associated with fluid overload, and improve the patients’ prognosis.