评估床旁超声测算下腔静脉膨胀指数对感染性休克患者液体复苏达标及预后的影响

To Evaluate the Effects of Subcava Dilatation Index Measured by Bedside Ultrasound on Fluid Resuscitation Standard and Prognosis in Septic Shock Patients

目的探究床旁超声测量计算下腔静脉膨胀指数(inferior vena cava variability,dIVC),评估该指标对感染性休克患者的液体复苏达标情况,分析其对治疗预后的影响。方法选取2020年1月—2022年2月在南京医科大学附属江宁医院重症医学科接受治疗的感染性休克病例83例纳入研究,按照不同监测技术将其分为对照组(n=41)和观察组(n=42)。对照组行常规监测;观察组在对照组基础上行dIVC监测,并以18%的dIVC阈值为临界点,当患者对容量无反应时,对其采用去甲肾上腺素治疗。对比分析两组患者液体复苏前后血流动力学指标以及转归指标。结果观察组复苏24 h的HR、CVP、入液量均低于对照组,差异有统计学意义(t=10.658,9.791、4.411,P<0.05),而MAP则高于对照组,差异有统计学意义(t=13.714,P<0.05);观察组24 h复苏达标率(71.43%)高于对照组(48.78%),差异有统计学意义(χ^(2)=4.443,P=0.035);观察组去甲肾上腺素介入时间短于对照组,差异有统计学意义(P<0.05);观察组复苏24 h血乳酸低于对照组,乳酸清除率高于对照组,差异有统计学意义(P<0.05);而两组ICU入住时间及28 d病死率比较,差异无统计学意义(P>0.05)。结论床旁超声测量计算dIVC可准确反应患者血液动力学变化,减少入液量,适时介入药物应对心肌抑制,降低血乳酸水平,更为准确地指导液体复苏治疗。

Objective To explore the bedside ultrasound measurement to calculate inferior vena cava distention index(inferior vena cava variability,dIVC),to evaluate the target situation of fluid resuscitation in septic shock patients,and to analyze its impact on treatment prognosis.Methods From January 2020 to February 2022,83 patients with septic shock treated in the Department of Critical Care Medicine of Jiangning Hospital Affiliated to Nanjing Medical University were enrolled in the study.They were divided into control group(n=41)and observation group(n=42)according to different monitoring techniques.The control group received routine monitoring.The observation group received dIVC monitoring on the basis of the control group,with the dIVC threshold of 18%as the critical point.When patients did not respond to volume,they were treated with norepinephrine.Hemodynamic parameters and outcome parameters before and after fluid resuscitation were compared between the two groups.Results HR,CVP and fluid intake at 24 h after resuscitation in observation group were lower than those in control group,the difference was statistically significant(t=10.658,9.791,4.411,P<0.05),while MAP was higher than that in control group,the difference was statistically significant(t=13.714,P<0.05).The compliance rate of 24 h resuscitation in observation group(71.43%)was higher than that in control group(48.78%),the difference was statistically significant(χ^(2)=4.443,P=0.035).The intervention time of noradrenaline in the observation group was shorter than that in the control group,the difference was statistically significant(P<0.05).The blood lactic acid in the observation group was lower than that in the control group after 24 h of resuscitation,and the lactic acid clearance rate was higher than that in the control group,the difference was statistically significant(P<0.05).There was no statistically significant difference in the admission time and 28 day mortality of ICU between the two groups(P>0.05).Conclusion bedside ultrasound measurement and calculation of dIVC can accurately reflect hemodynamic changes in patients,reduce fluid intake,timely intervention of drugs to respond to myocardial suppression,reduce blood lactic acid levels,and more accurately guide fluid resuscitation.