无创血流动力学监测在脓毒性休克早期复苏的应用

Application of Noninvasive Hemodynamic Monitoring in Early Resuscitation of Septic Shock

目的探讨无创血流动力学监测在脓毒性休克早期复苏临床应用价值。方法选取2021年3月-2021年7月深圳市人民医重症医学科并确诊为脓毒性休克的患者100例作为研究对象,随机分为对照组(n=50)和试验组(n=50)。所有患者均给予无创血流动力学监测床旁监测入重症医学科时(0h)、入科6h的心率(HR)、平均动脉压(MAP)、心输出量(CO)、心脏指数(CI)、每搏输出量(SV)、每搏输出量变异率(SVV)等指标;两组患者均按脓毒性休克指南进行休克复苏,试验组还根据无创血流动力学监测指标指导目标导向液体治疗(早期液体复苏及血管性药物使用)。比较两组患者的一般资料,治疗前后各项血流动力学指标的变化(包括HR、MAP、CO、CI、SV、SVV)和治疗6h后血乳酸、6h后血乳酸清除率、6h尿量变化及住ICU时间、28d病死率。结果①两组患者性别、年龄、急性生理与慢性健康评分(APACHE II评分)、序贯器官衰竭评分(SOFA)、入院时血乳酸、白细胞(WBC)、C反应蛋白(CRP)、降钙素原(PCT)、HR、MAP、CO、CI、SV、SVV均差异无统计学意义(P>0.05);②治疗6h后,两组患者在HR、MAP、CO、CI、SV、SVV差异均有统计学意义(P<0.05),其中试验组的MAP、CO、CI、SV较对照组明显增高(P<0.05),而试验组的HR、SVV较对照组明显降低(P<0.05);③治疗6h后,两组患者在血乳酸、血乳酸清除率、尿量差异均有统计学意义(P<0.05),其中试验组血乳酸较对照组明显下降(P<0.05)、而试验组血乳酸清除率、尿量较对照组显著升高(P<0.05);④两组预后比较、其中试验组ICU住院时间较对照组明显缩短,差异有统计学意义(P<0.05),而28d病死率在两组中无明显统计学意义(P>0.05)。结论无创血流动力学动态监测可指导脓毒性休克早期复苏,改善循环灌注、提高乳酸清除率、促进肾功能恢复、缩短ICU住院时间,同时有易操作、能无创持续监测、安全性高的优点,值得临床进一步推广。

Objective To explore the clinical value of noninvasive hemodynamic monitoring in early resuscitation of septic shock.Methods From March 2021 to July 2021,100 patients with septic shock were randomLy divided into control group(n=50)and experimental group(n=50).All patients were given noninvasive hemodynamic monitoring.The heart rate(HR),mean arterial pressure(MAP),cardiac output(CO),cardiac index(CI),stroke output(SV),stroke output variability(SVV)and other indexes were monitored at the time of admission to the intensive care department(0h)and 6 hours(6h);The patients in both groups underwent shock resuscitation according to the guidelines of septic shock.The experimental group also guided target oriented fluid therapy(early fluid resuscitation and use of vascular drugs)according to the non-invasive hemodynamic monitoring indicators.The general data of the two groups,the changes of hemodynamic indexes(including HR,map,CO,CI,SV and SVV)before and after treatment,blood lactate after 6 hours,blood lactate clearance after 6 hours,changes of urine volume after 6 hours,ICU stay and 28 day mort ality were compared.Results①There was no significant difference in gender,age,acute physiology and chronic health score(APACHE II score),sequential organ failure score(SOFA),blood lactate,leukocyte(WBC),C-reactive protein(CRP),procalcitonin(PCT),HR,MAP,CO,CI,SV and SVV between the two groups(P>0.05).②After 6 hours of treatment,there were significant differences in HR,map,Co,CI,SV and SVV between the two groups(P<0.05).Map,CO,CI and SV in the experimental group were significantly higher than those in the control group(P<0.05),while HR and SVV in the experimental group were significantly lower than those in the control group(P<0.05).③After 6 hours of treatment,there were significant differences in blood lactate,blood lactate clearance and urine volume between the two groups(P<0.05).The blood lactate in the experimental group was significantly lower than that in the control group(P<0.05),while the blood lactate clearance and urine volume in the experimental group were significantly higher than those in the control group(P<0.05).④Compared with the prognosis of the two groups,the length of ICU stay in the experimental group was significantly shorter than that in the control group(P<0.05),the difference was statistically significant,but the 28 day mortality was not statistically significant in the two groups(P>0.05).Conclusion Noninvasive hemodynamic dynamic monitoring can guide the early resuscitation of septic shock,improve circulatory perfusion,improve lactate clearance,promote the recovery of renal function and shorten the length of stay in ICU.At the same time,it has the advantages of easy operation,noninvasive continuous monitoring and high safety,which is worthy of further clinical promotion.