无创心排量联合中心静脉血氧饱和度监测对急性返流性胆管炎合并休克早期目标导向性液体复苏的指导作用

Effect of noninvasive cardiac output and central venous oxygen saturation monitoring on the early goal-directed fluid resuscitation in patients with acute reflux cholangitis and shock

目的探讨无创心排量(cardiac output,CO)联合中心静脉血氧饱和度(central venous oxygen saturation,ScvO2)监测对急性返流性胆管炎合并休克早期目标导向性液体复苏的指导作用。方法回顾性分析广州市花都区人民医院肝胆胰外科2015年1月至2019年12月间收治的94例急性返流性胆管炎合并休克患者资料,分为研究组和对照组两组,每组各47例。在指导早期液体复苏的治疗中,对照组监测患者平均动脉压(MAP)及中心静脉压(CVP)完成,研究组通过床旁多普勒无创血流动力学检测仪动态监测患者CO及经中心静脉导管监测患者ScvO2。比较两组早期容量达标时间、24 h后休克指数变化、治疗后6 h血乳酸清除率,治疗前及治疗后第3、7天APACHE-III评分的变化情况,治疗后并发症发生率和病死率。结果研究组早期容量达标时间较对照组明显缩短,24 h后休克指数较对照组明显降低,治疗后6 h血乳酸清除率明显高于对照组,且第3、7天的APACHE-III评分较对照组降低(均P<0.05);研究组治疗后并发的肝脓肿、肺部感染、急性肾功能衰竭及消化道出血发生率明显低于对照组(P<0.01),而脓毒血症发生率及病死率两组无明显差别(P>0.05)。结论临床上联合无创心排量和中心静脉血氧饱和度监测对急性返流性胆管炎合并休克患者早期液体管理具有良好指导作用,值得临床推广。

Objective To explore the guiding effect of noninvasive cardiac output(CO)and central venous oxygen saturation(ScvO2)monitoring on the early goal-directed fluid resuscitation in patients with acute reflux cholangitis and shock.Methods A total of 94 patients suffering from acute cholangitis complicated with shock from Jan.2015 to Dec.2019 were selected and studied retrospectively.All of the patients were divided into study group and control group,47 cases in each group.For the control group,the goal-directed fluid resuscitation was performed by monitoring the mean arterial pressure(map)and central venous pressure(CVP);for the study group,the goal-directed fluid resuscitation was guided by monitoring the CO by bedside Doppler noninvasive hemodynamic detector and monitoring the ScvO2 by central venous catheters.The time of early volume reaching standard,the change of shock index after 24 hours,blood lactate clearance 6 hours after treatment,the change of APACHE-III score before treatment,the 3rd day and the 7th day after treatment,and the early complications of acute reflux cholangitis as well as mortality were analyzed and compared between the two groups.Results Compared with the control group,the time of early volumn reaching standard was significantly shorter,the shock index was significantly lower after 24 hours,the blood lactate clearance rate was significantly higher after 6 hours,and the Apache-III score on 3rd and 7th day was significantly lower in the study group(all P<0.05).The liver abscess,lung infection,acute renal failure and gastrointestinal hemorrhage in the study group were significantly less than those in the control group(P<0.01),while there was no significant difference in toxemia or mortality between the two groups(P>0.05).Conclusion The combination of noninvasive cardiac output(CO)and central venous oxygen saturation(SCVO2)monitoring has an important guiding significance in early fluid management of patients with acute reflux cholangitis and shock,which is worthy of clinical promotion.