舌下微循环成像系统联合超声在脓毒性休克容量评估中的应用研究

Application of Hypoglossal Microcirculation Imaging System Combined with Ultrasound in the Capacity Evaluation of Septic Shock

目的:研究舌下微循环成像系统联合超声在脓毒性休克容量评估中的应用效果。方法:选取2019年10月-2021年6月笔者所在医院收治的80例脓毒性休克患者,随机分为普通组(n=20,补液试验指导容量评估)、超声组(n=20,超声指导容量评估)、微循环成像组(n=20,舌下微循环成像系统指导容量评估)、联合组(n=20,舌下微循环成像系统联合超声指导容量评估),四组患者均观察28 d,比较实施液体复苏前和实施液体复苏后6 h四组患者乳酸水平、血氧水平[中心静脉氧饱和度(ScvO_(2))、氧合指数(OI)]、器官功能状态[器官功能衰竭评分(SFOA)]。比较实施液体复苏后6 h四组患者乳酸清除率,观察四组患者重症加强护理病房(ICU)住院时间、28 d内死亡率。结果:液体复苏后6 h,四组患者乳酸水平、SFOA评分显著低于液体复苏前,且联合组<超声组、微循环成像组<普通组(P<0.05),超声组和微循环成像组比较差异无统计学意义(P>0.05);ScvO_(2)、OI显著高于液体复苏前,且联合组>超声组、微循环成像组>普通组(P<0.05),超声组和微循环成像组比较差异无统计学意义(P>0.05)。液体复苏后6 h,联合组乳酸清除率>超声组、微循环成像组>普通组(P<0.05),超声组和微循环成像组比较差异无统计学意义(P>0.05)。四组患者ICU住院时间比较差异有统计学意义(P<0.05),联合组<超声组、微循环成像组<普通组(P<0.05),超声组和微循环成像组比较差异无统计学意义(P>0.05);联合组、超声组和微循环成像组28 d内死亡率显著低于普通组(P<0.05),联合组略低于超声组和微循环成像组,但比较差异无统计学意义(P>0.05),超声组和微循环成像组比较差异无统计学意义(P>0.05)。结论:舌下微循环成像系统联合超声指导脓毒性休克患者容量评估改善患者乳酸水平、血氧水平、器官功能状态效果及促进患者康复、减少死亡率,效果优于二者单独使用。

Objective:To study the application effect of hypoglossal microcirculation imaging system combined with ultrasound in the capacity evaluation of septic shock.Method:A total of 80 patients with septic shock treated in the hospital were selected from October 2019 to June 2021 and they were randomly divided into the common group (n=20,fluid supplement test guidance of capacity evaluation),the ultrasound group (n=20,ultrasound guidance of capacity evaluation),the microcirculation imaging group (n=20,hypoglossal microcirculation imaging system guidance of capacity evaluation) and the combined group (n=20,hypoglossal microcirculation imaging system combined with ultrasound guidance of capacity evaluation).The four groups of patients were observed for 28 d.The lactate level,blood oxygen[central venous oxygen saturation (ScvO_(2)),oxygenation index (OI)]and organ function status[sequential organ failure assessment (SFOA)]before the implementation of fluid resuscitation and at 6 h after the implementation of fluid resuscitation.Lactate clearance rate at 6 h after the implementation of fluid resuscitation,intensive care unit (ICU) stay and mortality rate within 28 d were compared among the four groups of subjects.Result:At 6 h after fluid resuscitation,the lactate level and SFOA score of the four groups of patients were significantly lower than those before fluid resuscitation,and the level and score were shown that combined group < ultrasound group,microcirculation imaging group < common group (P<0.05),and there were no significant differences between ultrasound group and microcirculation imaging group (P>0.05).The ScvO_(2)and OI were obviously higher than those before fluid resuscitation,and the two indicators showed combined group > ultrasound group,microcirculation imaging group > common group (P<0.05),and the differences between ultrasound group and microcirculation imaging group had no statistical significance (P>0.05).At 6 h after fluid resuscitation,the lactate clearance rate was shown that combined group > ultrasound group,microcirculation imaging group > common group (P<0.05),and there was no statistical difference between ultrasound group and microcirculation imaging group (P>0.05).There was a statistical significance in the ICU stay among the four groups of patients,showed that combined group < ultrasound group,microcirculation imaging group < common group (P<0.05),but there was no significant difference between ultrasound group and microcirculation imaging group (P>0.05).The mortality rate within 28 d of combined group,ultrasound group and microcirculation imaging group was significantly lower than that of common group (P<0.05),and the mortality rate of combined group was slightly lower than that of ultrasound group and microcirculation imaging group,but there was no statistically significant difference (P>0.05),the rate of ultrasound group was not significantly different from that of microcirculation imaging group (P>0.05).Conclusion:Hypoglossal microcirculation imaging system combined with ultrasound for guidance of capacity evaluation of patients with septic shock is better than individual use of the two methods in improving the lactate level,blood oxygen level and organ function status,promoting the rehabilitation and reducing the mortality rate of patients.