不同液体复苏对脓毒症休克患者血流动力学状态改善的差异性研究及对患者生存情况的影响

Effects of different resuscitation fluids on hemodynamic improvement in patients with septic shock

目的探讨不同液体复苏对脓毒症休克患者血流动力学状态改善的差异性及对患者生存情况的影响。方法选取2020年10月—2021年6月海南省人民医院治疗的脓毒症休克患者64例,将所有患者按随机数字表法列入4个治疗组,每组患者给予不同复苏液,其中A组给予生理盐水;B组给予羟乙基淀粉溶液;C组给予乳酸林格液;D组给予醋酸钠钾镁钙葡萄糖注射液,观察并统计各组复苏6 h后达标率,统计各组患者复苏前与复苏后72 h危重病病情评价APACHEⅡ评分,采用深心输出量测量仪观测各组患者复苏前与复苏后72 h的心率(HR)、平均动脉压(MAP)及心脏指数(CI),记录14 d和28 d患者病死率。结果A组、B组、C组、D组患者复苏6 h后达标率比较无统计学差异(P>0.05);C组、D组患者复苏后72 h APACHEⅡ评分低于复苏前(P<0.05),且D组患者复苏后72 h APACHEⅡ评分低于C组(P<0.05);C组、D组患者复苏后72 h HR低于复苏前(P<0.05),C组、D组患者复苏后72 h CI、MAP高于复苏前(P<0.05),且D组患者复苏后72 h HR低于对照组(P<0.05);A组、B组、C组、D组患者的14 d病死率比较差异存在统计学差异(P<0.05),A组、B组、C组、D组患者的28 d病死率比较差异无统计学意义(P>0.05)。结论醋酸钠钾镁钙葡萄糖注射液复苏可有效降低脓毒症休克患者的APACHEⅡ评分,改善其血流动力学,降低其14 d病死率,改善其预后。

Objective To investigate the difference of different fluid recovery on hemodynamic status and the survival of septic shock.Methods 64 patients with septic shock treated in our hospital from October 2020 to June 2021 were selected.All patients were included in the four treatment groups by randomized digital tables,and each group was given different resuscitation fluids,Where group A was administered with normal saline;Group B was given a hydroxyethyl starch solution;Group C administered lactate;Group D administered sodium potassium magnesium acetate calcium glucose injection.Observe and count the compliance rate after 6 h of recovery in each group,APACHEⅡscores for critical illness before and 72 h after recovery,heart rate before and 72 h after resuscitation using a deep-heart output meter(HR),mean arterial pressure(MAP)and the cardiac index(CI),and case fatality rates were recorded at 14 d and 28 d in patients.Results There was no statistical difference in group A,B,C and D after recovery(P>0.05);Patients in groups C and D had lower 72 h APACHEⅡscores after recovery than before resuscitation(P<0.05).Moreover,Group D had a lower 72 h APACHEⅡscore after recovery than in group C(P<0.05);Patients in groups C and D had a lower 72 h HR after recovery than before recovery(P<0.05),Group C and D patients had a higher 72 h CI and MAP after recovery than before recovery(P<0.05).Besides,the HR was lower at 72 h after recovery than in the control group(P<0.05);Statistical differences were found in the 14 d fatality rates of patients in groups A,B,C,and D(P<0.05),There was no statistical difference in 28 d mortality rates in groups A,B,C,and D(P>0.05).Conclusion Recovery of sodium potassium and magnesium acetate calcium glucose injection can effectively reduce the APACHEⅡscore,improve their hemodynamics,reduce the 14 d case fatality rate,and improve their prognosis.