基于PICCO评估床旁超声指导感染性休克患者液体复苏效果的研究

A study on the effect of bedside ultrasound based on PICCO assessment to guide fluid resuscitation in patients with septic shock

目的研究基于PICCO评估床旁超声指导感染性休克患者液体复苏的效果。方法选取2017年5月~2018年5月东莞市人民医院重症医学科收治的感染性休克患者116例,随机分为对照组和观察组,每组各58例。对照组采用PICCO方法指导液体复苏,观察组采用床旁超声指导液体复苏。观察时间为24h,比较两组患者治疗前后的血气指标以及其他相关临床指标,并比较两组的预后情况。结果治疗前两组各项血气指标比较,差异无统计学意义(P>0.05);治疗后,观察组OI明显高于对照组,差异有统计学意义[(150.28±11.68)mm Hg vs.(95.61±11.54)mm Hg,P<0.05],其余PCT、MAP、CVP指标两组比较,差异无统计学意义(P>0.05)。观察组复苏液体量[(1.02±0.33)L vs.(2.19±0.90)L]、休克纠正时间[(4.41±1.62)h vs.(8.32±1.64)h,]、机械通气时间[(3.87±0.69)d vs.(7.07±1.25)d]、ICU住院时间[(8.25±3.04)d vs.(12.16±4.50)d]明显低于对照组,差异有统计学意义(P<0.05)。观察组肺水肿发生率为10.34%、CRRT需求率为13.79%、7d死亡率为3.45%,分别低于对照组的41.38%、58.62%、20.69%,差异有统计学意义(P<0.05)。结论在感染性休克患者的治疗中,采用床旁超声指导PICCO方法指导液体复苏,对于患者液体复苏有良好的指导意义,是传统PICCO方法的有效补充。

Objective To investigate the effect of bedside ultrasound based on PICCO assessment to guide fluid resuscitation in patients with septic shock.Methods A total of 116 patients with septic shock admitted to the Intensive Care Unit(ICU)of Dongguan people's hospital from May 2017 to May 2018 were selected as the research objects and randomly divided into the observation group(n=58)and the control group(n=58).The control group was treated by PICCO method to guide liquid resuscitation,while the observation group was treated by bedside ultrasound to guide liquid resuscitation.The observation time was 24h.Blood gas indicators and other relevant clinical indicators before and after treatment were compared between the two groups,and the prognosis of the two groups was compared.Results Before treatment,there was no statistically significant difference in blood gas indicators between the two groups(P>0.05).After treatment,OI in the observation group was significantly higher than that in the control group,and the difference was statistically significant([150.28±11.68]mm Hg vs.[95.61±11.54]mm Hg,P<0.05).Other PCT,MAP and CVP indicators in the two groups showed no statistically significant difference(P>0.05).The resuscitation fluid volume([1.02±0.33]L vs.[2.19±0.90]L),shock correction time([4.41±1.62]h vs.[8.32±1.64]h),duration of mechanical ventilation([3.87±0.69]d vs.[7.07±1.25]d),and length of ICU stay([8.25±3.04]d vs.[12.16±4.50]d)in the observation group were significantly lower than those in the control group,with statistically significant differences(P<0.05).The incidence of pulmonary edema,the demand rate of CRRT and the 7d mortality in the observation group were 10.34%,13.79%and 3.45%,respectively,lower than those in the control group(41.38%,58.62%and 20.69%,respectively),with statistically significant differences(P<0.05).Conclusion In the treatment of patients with septic shock,bedside ultrasound based on PICCO method is used to guide fluid resuscitation,which has a good guiding significance to fluid resuscitation in patients and is an effective supplement to traditional PICCO method.