Vigileo微创监测指导脓毒性休克液体复苏的效果分析

Effect of Vigileo minimally invasive monitoring on fluid resuscitation in septic shock

目的观察FloTrac/Vigileo动态监测指导脓毒性休克患者进行液体复苏的效果。方法选取2020年1月~2021年12月保定市第二中心医院86例脓毒性休克患者,随机数表法分为对照组和Vigileo组,各43例。对照组以中心静脉压指导早期目标导向治疗(EGDT)。Vigileo组连续监测每搏输出量(SV)、每搏变异度(SVV)等指标,指导补液。比较两组达到EGDT时间、6、24 h补液量,液体复苏前和复苏6、24 h的血乳酸、血乳酸清除率及中心静脉氧饱和度(ScvO2),多器官功能障碍综合征(MODS)发生率、28 d死亡率,ICU入住时间及并发症情况。结果Vigileo组达到EGDT时间、6和24 h补液量均低于对照组,组间差异有统计学意义(P<0.05)。两组复苏前血乳酸、ScvO2差异均无统计学意义(P>0.05)。液体复苏后血乳酸降低、ScvO2升高,6和24 h与复苏前比较差异均有统计学意义(P<0.05),6 h、24 h Vigileo组的血乳酸水平低于对照组,乳酸清除率和ScvO2高于对照组,组间差异均有统计学意义(P<0.05)。Vigileo组入住ICU时间短于对照组,组间差异有统计学意义(P<0.05),Vigileo组MODS发生率和死亡率略低于对照组,但组间差异无统计学意义(P>0.05)。患者均未出现感染、出血、栓塞等并发症。结论应用FloTrac/Vigileo监测指导脓毒性休克患者的液体复苏,较CVP能更快改善全身组织灌注,避免液体过负荷,且微创、操作简便无需校准,并发症少,适合在ICU危重患者中应用。

Objective To observe the effect of FloTrac/Vigileodynamic monitoring on fluid resuscitation in patients with septic shock.Methods 86 patients with septic shock were randomly divided into control group and Vigileo group.The control group was treated with EGDT guided by central venous pressure.Vigileo group continuously monitored SV,SVV and other indicators to guide fluid replacement.The time to reach EGDT,6h rehydration volume,24h rehydration volume,blood lactate,blood lactate clearance rate,ScvO2,incidence of MODS,28 day mortality,ICU stay time,and other complications were compared between the two groups.Results The time to reach EGDT,6h and 24h rehydration volume in Vigileo group were lower than those in the control group,and the difference was statistically significant(P<0.05).,There was no significant difference in blood lactate and ScvO2 between the two groups before resuscitation(P>0.05).After fluid resuscitation,the blood lactic acid decreased and ScvO2 increased.There were significant differences between 6h and 24h before resuscitation(P<0.05).The blood lactic acid level in the 6h and 24h Vigileo group was lower than that in the control group,and the lactic acid clearance rate and ScvO2 were higher than that in the control group.There were significant differences between the groups(P<0.05).The length of stay in ICU in the Vigileo group was shorter than that in the control group,and the difference between the groups was statistically significant(P<0.05).The incidence and mortality of MODS in the Vigileo group were slightly lower than that in the control group,but the difference between the groups was not statistically significant(P>0.05).There were no complications such as infection,bleeding and embolism.Conclusion Using FloTrac/Vigileo monitoring to guide fluid resuscitation in patients with septic shock can improve systemic tissue perfusion faster than CVP,avoid fluid overload,minimally invasive,simple operation,no calibration and less complications.It is suitable for critical patients in ICU.