持续泵入氯化钠对低血容量休克患者去甲肾上腺素治疗后血流动力学的影响

Effect of pumping normal saline after norepinephrine therapy on hemodynamics of patients with hypovolemic shock

目的探讨冲封管前持续泵入0.9%氯化钠溶液对低血容量休克患者泵入去甲肾上腺素后血流动力学的稳定作用。方法选择2018年8月至2019年6月入住中山大学附属第三医院肝外ICU56例低血容量休克患者作为研究对象。按照随机数字表法分为观察组和对照组,每组28例。对照组采用常规方法冲封管;观察组冲封管前先用2 ml0.9%氯化钠溶液按原始泵入速度继续泵入,再按照常规方法冲封管。比较2种方法对患者冲封管后血流动力学的影响。结果冲封管后30 s、1 min、2 min、3 min、5 min观察组收缩压分别为(105.4±17.4)、(106.3±21.3)、(102.1±14.5)、(100.6±16.9)、(101.0±14.3)mmHg(1 mmHg=0.133 kPa),平均动脉压分别为(81.1±8.6)、(82.4±9.9)、(78.6±7.3)、(76.9±6.7)、(75.7±6.5)mmHg,低于对照组的(150.6±26.7)、(151.8±30.1)、(139.7±29.8)、(125.3±25.3)、(114.4±21.6)mmHg和(107.4±11.6)、(106.1±11.5)、(98.1±11.1)、(88.9±9.6)、(79.5±8.0)mmHg,差异有统计学意义(t值为6.432~31.133,P<0.01)。冲封管后30 s、1 min、2 min、3 min观察组舒张压为(69.0±10.5)、(70.5±10.7)、(66.9±8.3)、(65.1±6.2)mmHg,低于对照组的(85.9±11.6)、(83.3±8.7)、(77.3±7.4)、(70.7±7.2)mmHg,差异有统计学意义(t值为10.199~18.464,P<0.01)。结论冲封管前,先抽取2 ml 0.9%氯化钠溶液按原始泵入速度继续泵入,再用常规方法冲封管,可降低泵入去甲肾上腺素患者血流动力学异常波动的风险。

Objective To explore the effect of continuous pumping normal saline at same infusion speed before flushing or sealing the tube on the hemodynamics of patients with hypovolemic shock receiving norepinephrine.Methods A total of 56 cases of hypovolemic shock patients receiving norepinephrine via micro-pump were randomly assigned to the observation group and the control group(28 cases in each group).Patients in the control group received conventional operation method to flush or seal the tube,while patients in the observation group continued pumping normal saline at the same infusion speed,followed by flushing or sealing the tube based on the control group.The changes of hemodynamics after flushing or sealing the tube was compared between two groups.Results After 30 s,1 min,2 min,3 min,5 min of flush or seal the tube,the systolic blood pressure were(105.4±17.4)mmHg,(106.3±21.3)mmHg,(102.1±14.5)mmHg,(100.6±16.9)mmHg,(101.0±14.3)mmHg(1 mmHg=0.133 kPa),mean arterial blood pressure were(81.1±8.6)mmHg,(82.4±9.9)mmHg,(78.6±7.3)mmHg,(76.9±6.7)mmHg,(75.7±6.5)mmHg in the observation group,lower than those in the control group[(150.6±26.7)mmHg,(151.8±30.1)mmHg,(139.7±29.8)mmHg,(125.3±25.3)mmHg,(114.4±21.6)mmHg and(107.4±11.6)mmHg,(106.1±11.5)mmHg,(98.1±11.1)mmHg,(88.9±9.6)mmHg,(79.5±8.0)mmHg],the differences were statically significant(P<0.05).After 30 s,1 min,2 min,3 min of flush or seal the tube,the diastolic blood pressure were(69.0±10.50)mmHg,(70.5±10.7)mmHg,(66.9±8.3)mmHg,(65.1±6.2)mmHg in the observation group,lower than those in the control group[(85.9±11.6)mmHg,(83.3±8.7)mmHg,(77.3±7.4)mmHg,(70.7±7.2)mmHg],the differences were statically significant(t value was 10.199-18.464,P<0.05).Conclusions Before flushing or sealing the tube,continue pumping normal saline at same infusion speed can reduce the risk of abnormal hemodynamics for the hypovolemic shock patients receiving norepinephrine via micro-pump.