负平衡液体管理对合并急性肺损伤感染性休克患者早期复苏的影响

Effect of Liquid Negative Balance on Early Resuscitation of Septic Shock Patients Complicated with Acute Lung Injury

目的:探讨负平衡液体管理对合并急性肺损伤(ALI)感染性休克患者的早期复苏影响。方法:将2017年12月-2019年12月笔者所在医院收治的60例伴ALI的感染性休克患者随机分为治疗组(30例)和对照组(30例),其中治疗组患者采用负平衡液体管理方法,对照组采用出入平衡或适当正平衡液体管理方法,监测两组入院后不同时间平均动脉压(MAP)、中心静脉压(CVP)、心指数(CI)、血管外肺水指数(ELWI)、氧合指数(PaO2/FiO2),治疗后APACHEⅡ评分,并进行比较。结果:治疗后不同时间两组各项心功能指标均优于治疗前,其中治疗后5,7 d,治疗组MAP均高于对照组,差异均有统计学意义(P<0.05),治疗后各时间两组CVP、CI比较差异均无统计学意义(P>0.05)。治疗后不同时间两组各项肺功能指标均优于治疗前,且治疗后5、7 d治疗组PaO2/FiO2、ELWI均高于对照组,差异均有统计学意义(P<0.05)。治疗后12、24、48 h治疗组APACHEⅡ评分均低于对照组,差异均有统计学意义(P<0.05)。结论:采用负平衡液体管理方法治疗合并ALI感染性休克患者可以改善患者心肺功能,具有良好的临床疗效,有利于患者早期复苏。

Objective:To explore effect of liquid negative balance on early resuscitation of septic shock patients complicated with acute lung injury (ALI).Method:Sixty septic shock patients complicated with ALI treated in our hospital from December 2017 to December 2019 were randomly divided into the treatment group (30 cases) and the control group (30 cases).The patients in the treatment group were treated with liquid negative balance and the patients in the control group were treated with the maintenance of balance of fluid intake and output or proper positive-balanced liquid management method.The mean arterial pressure (MAP),central venous pressure (CVP),cardiac index (CI),extravascular pulmonary water index (ELWI) and oxygenation index (PaO2/FiO2) of the two groups at different times after admission were monitored and compared.The APACHE Ⅱ scores after treatment were monitored and compared.Result:All cardiac function indexes in the two groups at different times after treatment were better than those before treatment,among which,MAP in the treatment group was higher than that in the control group at 5,7 days after treatment,the differences were statistically significant (P<0.05),and CVP and CI in the two groups at different times after treatment were not statistically significant (P>0.05).Lung function indicators in the two groups at different times after treatment were all better than those before treatment,PaO2/FiO2 and ELWI in the treatment group were all higher than those in the control group at 5 and 7 days after treatment,the differences were statistically significant (P<0.05).The APACHE Ⅱ scores in the treatment group at 12,24,48 h after treatment were lower than those in the control group,the differences were statistically significant (P<0.05).Conclusion:The use of liquid negative balance in treatment of septic shock patients complicated with ALI can improve the cardiopulmonary function of patients.The liquid negative balance has good treatment effect on septic shock patients complicated with ALI.The clinical effect is conducive to the early recovery of patients.