床旁超声指导重症脓毒症患者早期液体复苏的临床意义

Clinical Significance of Bedside Ultrasound in Guiding Early Fluid Resuscitation in Patients with Severe Sepsis

目的研究床旁超声指导重症脓毒症患者早期液体复苏的临床效果。方法选取秀山土家族苗族自治县人民医院2018年1月—2020年1月收治的100例重症脓毒症患者作为研究对象,按照随机数字表法分成对照组和观察组,各50例。对照组患者通过脉搏指示剂持续心排血量法监测血容量指数,观察组患者通过床旁超声监测下腔静脉内径。比较两组患者治疗前、液体复苏后中心静脉压(CVP)、平均动脉压(MAP)、中心静脉血氧饱和度(ScvO_(2));液体复苏达标率;液体复苏用量、血管活性药物用量;肺水肿发生率、28 d病死率。结果液体复苏6、12 h后,两组患者的CVP、MAP、ScvO_(2)_(2)水平比较,差异无统计学意义(P>0.05);观察组患者的复苏6、24、36 h达标率均高于对照组患者,差异有统计学意义(P<0.05);观察组患者液体复苏用量少于对照组,差异有统计学意义(P<0.05);观察组患者的血管活性药物用量和对照组比较,差异无统计学意义(P>0.05);观察组患者肺水肿发生率(4.0%)低于对照组(20.0%),差异有统计学意义(χ^(2)=6.061,P<0.05)。结论重症脓毒症患者通过床旁超声指导早期液体复苏,能够提升液体复苏达标率,减少液体复苏用量,降低肺水肿发生率。

Objective To study the clinical effect of bedside ultrasound in guiding early fluid resuscitation in patients with severe sepsis.Methods 100 patients with severe sepsis treated in Xiushan Tujia and Miao Autonomous County People′s Hospital from January 2018 to January2020 were selected as the research objects.They were randomly divided into control group and observation group,with 50 cases in each group.The patients in the control group were monitored by pulse indicator continuous cardiac output method to monitor the blood volume index of the patients,and the patients in the observation group were monitored by bedside ultrasound to monitor the inner diameter of the inferior vena cava,to compare thecentral venous pressure(CVP),mean arterial pressure(MAP),central venous oxygen saturation(ScvO_(2)),fluid resuscitation compliance rate,fluid resuscitation dosage,vasoactive drug dosage,lung Edema incidence and 28 d mortality.Results After 6 h and 12 h of fluid resuscitation,there was no statistically significant difference in the levels of CVP,MAP and ScvO_(2)between the two groups(P>0.05).The compliance rates of 6 h,24 h,and 36 h resuscitation in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).The amount of fluid resuscitation in the observation group was less than that in the control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the amount of vasoactive drugs between the observation group and the control group(P>0.05).The incidence of pulmonary edema in the observation group was 4.0%lower than that in the control group(20.0%),and the difference was statistically significant(χ^(2)=6.061,P<0.05).Conclusion In patients with severe sepsis,bedside ultrasound to guide early fluid resuscitation can improve the rate of fluid resuscitation,reduce the amount of fluid resuscitation,and reduce the incidence of pulmonary edema.