基于每搏量变异度的液体复苏方式对脓毒症休克患者组织氧代谢及预后的影响

Influence of fluid resuscitation method based on stroke volume variability on tissue oxygen metabolism and prognosis of patients with septic shock

目的观察基于每搏量变异度(SVV)的液体复苏方式对脓毒症休克患者组织氧代谢及预后的影响。方法选择2017年8月—2019年9月新疆医科大学第一附属医院急救·创伤中心急诊内科收治脓毒症休克患者98例作为研究对象,采用随机数字表法分为对照组和观察组,各49例。对照组给予常规治疗,观察组给予SVV指导下的液体复苏治疗,观察2组患者血流动力学指标[心率(HR)、心排指数(CI)、平均动脉压(MAP)]及部分组织灌注指标[乳酸(Lac)、尿量、中心静脉血氧饱和度(ScvO2)]、全身氧代谢指标[氧供(DO2)、氧耗(VO2)]变化情况,并分析2组患者预后情况。结果与复苏前比较,复苏后2组患者HR下降、MAP升高,且观察组较对照组变化明显(t/P=24.755/0.000,8.705/0.000);与复苏前比较,2组患者复苏后的Lac水平降低,尿量增加,ScvO2水平升高,且观察组较对照组变化更明显(t/P=12.762/0.000,2.580/0.011,6.336/0.000);与复苏前比较,2组患者复苏后DO2无明显变化,VO2水平升高,且观察组升高较对照组更明显(t/P=0.285/0.776、13.356/0.000)。观察组14 d病死率明显低于对照组(χ2=3.879,P=0.048),2组28 d病死率比较差异无统计学意义(P>0.05),在28 d存活的患者中,观察组ICU住院时间、机械通气时间明显较对照组缩短,APACHEⅡ评分较对照组降低(t/P=7.107/0.000、14.584/0.000、16.677/0.000)。结论基于SVV的液体复苏方式较常规治疗更有助于改善患者血流动力学及组织氧代谢障碍,并可改善患者预后,具有临床应用价值。

Objective To observe the effect of fluid resuscitation based on stroke volume variability(SVV)on tissue oxygen metabolism and prognosis of patients with septic shock.Methods From August 2017 to September 2019,98 patients with septic shock admitted to the Emergency Department of the First Affiliated Hospital of Xinjiang Medical University in the Emergency Department of Trauma Center were selected as the research objects,and were divided into the control group and the observation group using a random number table,each with 49 example.The control group was given conventional treatment,and the observation group was given liquid resuscitation under the guidance of SVV.Hemodynamic indexes[heart rate(HR),cardiac output index(CI),mean arterial pressure(MAP)]and partial tissue perfusion were observed in the two groups The changes of indicators[lactate(Lac),urine output,central venous oxygen saturation(ScvO2)],systemic oxygen metabolism indicators[oxygen supply(DO2),oxygen consumption(VO2)],and the prognosis of the two groups were analyzed.Results Compared with before resuscitation,HR decreased and MAP increased in the two groups after resuscitation,and the observation group changed significantly compared with the control group(t/P=24.755/0.000,8.705/0.000).Compared with before resuscitation,the Lac level of the two groups after resuscitation decreased,the urine output increased,and the ScvO2 level increased,and the observation group changed more significantly than the control group(t/P=12.762/0.000,2.580/0.011,6.336/0.000).Compared with before resuscitation,the DO2 of the two groups of patients did not change significantly after resuscitation,and the level of VO2 increased,and the increase in the observation group was more significant than that in the control group(t/P=0.285/0.776,13.356/0.000).The 14-day mortality rate of the observation group was significantly lower than that of the control group(χ2=3.879,P=0.048),and there was no significant difference in the 28-day mortality rate between the two groups(P>0.05).Among patients who survived 28 days,the length of ICU hospitalization and mechanical ventilation in the observation group were significantly shorter than those in the control group,and the APACHEⅡscore was lower than that in the control group(t/P=7.107/0.000,14.584/0.000,16.677/0.000).Conclusion SVV-based fluid resuscitation is more helpful than conventional treatment to improve the patient's hemodynamics and tissue oxygen metabolism disorders,and can improve the prognosis of patients,and has clinical application value.