重症超声指导重症感染性休克患者行液体复苏效果观察

Observation on the effect of fluid resuscitation guided by severe ultrasound in patients with severe septic shock

目的探讨重症超声指导下重症感染性休克患者行液体复苏效果。方法选取2018年5月至2020年10月收治的72例重症感染性休克患者,随机分为观察组和对照组,各36例。对照组给予常规液体复苏,观察组给予重症超声指导下液体复苏,比较两组治疗前后血流动力学指标[中心静脉压(central venous pressure,CVP)、平均动脉压(mean arterial pressure,MAP)、心排出量(cardiac output,CO)、氧合指数(PaO_(2)/FiO_(2))]、血乳酸、中心静脉血氧饱和度(ScvO_(2))、细胞免疫指标(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)T淋巴细胞)、体液免疫指标(IgA、IgG、IgM)、临床指标及预后情况。结果治疗前,各指标水平差异无统计学意义(P>0.05),治疗后6、24 h,两组血流动力学指标水平和ScvO_(2)水平均显著上升,血乳酸水平显著下降,且治疗后6、24 h观察组MAP、PaO_(2)/FiO_(2)、ScvO_(2)水平高于对照组(P<0.001),血乳酸指标水平低于对照组(P<0.05)。治疗后两组细胞免疫指标、体液免疫指标水平均显著上升,且治疗后观察组CD4^(+)、CD4^(+)/CD8^(+)T淋巴细胞和IgM水平显著高于对照组(P<0.05)。观察组机械通气时间较对照组显著缩短,24 h输液量较对照组显著减少(P<0.05),两组24 h去甲肾上腺素用量无显著性差异(P>0.05),观察组多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)发生率、28 d病死率分别为11.11%、8.33%,较对照组33.33%、25.00%显著降低(P<0.05)。结论重症超声指导下对感染性休克患者进行液体复苏效果更优,促进患者血流动力学改善,保护患者心肺功能,改善患者细胞和液体免疫水平,降低病死率,提高患者生活质量,值得临床推广。

Objective To investigate and analyze the effect of fluid resuscitation in patients with severe septic shock under the guidance of critical ultrasound.Methods A total of 72 patients with severe septic shock who were treated from May 2018 to October 2020 were randomly divided into an observation group and a control group,36 cases in each.The control group was given routine body fluid resuscitation,and the observation group was given fluid resuscitation under the guidance of critical ultrasound.Hemodynamic indexes[central venous pressure(CVP),mean arterial pressure(MAP),cardiac output(CO),oxygenation index(PaO_(2)/FiO_(2))],blood lactate,central venous oxygen saturation(ScvO_(2)),cellular immune indicators(CD4^(+),CD8^(+),CD4^(+)/CD8^(+)T lymphocytes),humoral immune indicators(IgA,IgG,IgM),clinical indicators and prognosis were compared between the two groups before and after treatment.Results Before treatment,there was no significant difference in the levels of each index(P>0.05).At 6 and 24 h after treatment,the levels of hemodynamic indexes and ScvO_(2) in the two groups were significantly increased,and the blood lactate level was significantly decreased.And 6 and 24 h after treatment,the levels of MAP,PaO_(2)/FiO_(2),and ScvO_(2) in the observation group were higher than those in the control group(P<0.001),and the levels of blood lactate indexes in the observation group were lower than those in the control group(P<0.05).After treatment,the levels of cellular immune indexes and humoral immune indexes in the two groups were significantly increased,and the levels of CD4^(+),CD4^(+)/CD8^(+)T lymphocytes and IgM in the observation group were significantly higher than those in the control group after treatment(P<0.05).The mechanical ventilation time in the observation group was significantly shorter than that in the control group,and the 24-hour infusion volume was significantly lower than that in the control group(P<0.05).The incidence of multiple organ dysfunction syndrome(MODS)and 28-day mortality in the observation group were 11.11%and 8.33%,respectively,which were significantly lower than those in the control group,which were 33.33%and 25.00%(P<0.05).Conclusion The effect of fluid resuscitation in patients with septic shock under the guidance of critical ultrasound is better,which can promote the improvement of hemodynamics,protect the cardiopulmonary function,improve the level of cellular and humoral immunity,reduce the fatality rate,and improve the quality of life of patients,which is worthy of promotion.