重症超声对脓毒性休克合并HFpEF患者液体复苏的价值

The value of critical care ultrasound for fluid resuscitation in patients with septic shock combined with HFpEF

目的探讨重症超声对脓毒性休克合并射血分数保留型心力衰竭(HFpEF)患者液体复苏的价值。方法选择2019年1月至2021年12月杭州师范大学附属医院收治的脓毒性休克合并HFpEF患者60例,分为重症超声指导下的液体复苏患者(观察组)和常规方法的液体复苏患者(对照组),各30例。比较两组患者复苏前后的心率、平均动脉压(MAP)、中心静脉压(CVP)、脉搏血氧饱和度(SpO_(2))、中心静脉血氧饱和度(ScvO_(2))、血乳酸、脑钠肽、心脏指数(CI)、左心室流出道血流速度时间积分(VTI),对比两组人均复苏阶段液体总摄入量、血管活性药物使用量、肺水肿发生率、ICU停留时间和28 d病死率。结果观察组患者复苏6 h、24 h MAP、CVP、SpO_(2)、ScvO_(2)水平均高于对照组,心率和血乳酸均低于对照组,差异均有统计学意义(均P<0.05)。观察组患者复苏24、48、72 h脑钠肽水平均低于对照组,且均低于复苏前,CI、VTI水平均高于对照组及复苏前,差异均有统计学意义(均P<0.05)。观察组患者人均复苏阶段液体总摄入量、血管活性药物使用量、肺水肿发生率和ICU停留时间均短于对照组,差异均有统计学意义(均P<0.05)。两组患者28d病死率比较,差异无统计学意义(P>0.05)。结论重症超声对脓毒性休克合并HFpEF患者进行液体复苏有指导作用。

Objective To investigate the value of critical care ultrasound(CCU)-guided fluid resuscitation in patients with septic shock and heart failure with preserved ejection fraction(HFpEF).Methods Sixty septic shock patients with HFpEF admitted to the Affiliated Hospital of Hangzhou Normal University from January 2019 to December 2021 were selected and divided into observation group with fluid resuscitation under the guidance of CCU and control group with fluid resuscitation guided by conventional methods,with 30 cases in each group.Heart rate,mean arterial pressure(MAP),central venous pressure(CVP),SpO_(2),ScvO_(2),blood lactate,brain natriuretic peptide(BNP),cardiac index(CI),velocity-time integral(VTI)of left ventricular outflow tract blood flow before and after resuscitation were compared between the two groups.The total fluid intake,vasoactive drug use,incidence of pulmonary edema,ICU stay time during resuscitation and 28-d mortality were compared between the two groups.Results MAP,CVP,SpO_(2)and ScvO_(2)were significantly higher,and heart rate and blood lactate were significantly lower in the observation group at 6 h and 24 h of resuscitation than those in the control group(all P<0.05).BNP in the observation group at 24,48 and 72 h of resuscitation were significantly lower than those in the control group,and those before resuscitation.CI and VTI in the observation group at 24,48 and 72 h of resuscitation were significantly higher than those in the control group and those before resuscitation(all P<0.05).The mean total fluid intake and the use of vasoactive drugs during the resuscitation,the incidence of pulmonary edema and ICU stay time were significantly lower in the observation group than in the control group(all P<0.05).The 28d mortality was not significantly different between the two groups(P>0.05).Conclusion CCU may aid in the guidance of fluid resuscitation in patients with septic shock combined with HFpEF.