超声心动图在感染性休克液体复苏中的应用价值

Study on the application value of echocardiography in fluid resuscitation of septic shock

目的探讨超声心动图在感染性休克液体复苏中的应用价值。方法选择2020年1月至2021年6月本院收治的感染性休克患者80例,随机分为对照组和观察组各40例。两组均进行液体复苏治疗,治疗期间对照组使用脉搏连续心排血量监测(Pulse indicator continous cadiac output,PiCCO),观察组使用超声心动图评估。比较两组临床指标、氧合指数、血流动力学指标。结果观察组乳酸清除率高于对照组,机械通气时间、复苏液体量、入住重症监护室(ICU)时间均少于对照组,差异有统计学意义(P<0.05);两组治疗前氧合指数、血流动力学指标比较,差异均无统计学意义(P>0.05);两组治疗后氧合指数、平均动脉压(MAP)、中心静脉压(CVP)高于治疗前,心率低于治疗前,且观察组氧合指数高于对照组,差异有统计学意义(P<0.05)。结论在感染性休克液体复苏过程中使用超声心动图或PiCCO监测指导均能改善患者血流动力学指标,但超声心动图评估利于提高乳酸清除率与氧合指数,减少复苏液体量,缩短治疗时间,临床应用效果更佳。

Objective To explore the application value of echocardiography in fluid resuscitation in septic shock.Methods Eighty patients with septic shock admitted to our hospital from January 2020 to June 2021 were selected and randomly divided into the control group and the observation group,with 40 cases in each group.Both groups were treated with fluid resuscitation.During the treatment period,the control group was monitored by pulse indicator continous cadiac output(PiCCO),and the observation group was assessed by echocardiography.The clinical indexes,oxygenation index,and hemodynamic indexes of the two groups were compared.Results The lactic acid clearance rate of the observation group was higher than that of the control group,mechanical ventilation time,resuscitation fluid volume,the time of staying in the intensive care unit(ICU)were less than those of the control group,the difference was statistically significant(P<0.05).The comparison of oxygenation index and hemodynamic index between the two groups before treatment was not statistically significant(P>0.05);the oxygenation index,mean arterial pressure(MAP),central venous pressure(CVP)of the two groups after treatment were higher than before treatment,heart rate was lower than before treatment,and the oxygenation index of the observation group was higher than that of the control group,the difference was statistically significant(P<0.05).Conclusion The use of echocardiography or PiCCO monitoring and guidance during fluid resuscitation in septic shock can improve the hemodynamic indicators of the patients,but echocardiography assessment is beneficial to improve the lactic acid clearance rate and oxygenation index,reduce the amount of resuscitation fluid,and shorten the patient's treatment time,the clinical application effect is better.