重症超声指导下液体复苏联合针对性护理在脓毒性休克患者中的应用效果分析

Application Effect Analysis of Critical Ultrasound-Guided Fluid Resuscitation Combined with Targeted Nursing in Patients with Septic Shock

目的:探讨重症超声指导下液体复苏联合针对性护理在脓毒性休克患者中的应用效果。方法:选取2019年1月—2022年1月东台市人民医院收治的90例脓毒性休克患者作为研究对象,根据随机数字表法分为对照组与观察组,各45例。对照组实施常规液体复苏联合针对性护理,观察组在对照组基础上实施重症超声指导,比较治疗效果。结果:观察组治疗6、24、72 h后液体复苏达标率均高于对照组,差异有统计学意义(P<0.05)。治疗后,观察组平均动脉压、中心静脉压、心脏排量均高于对照组,心率低于对照组,差异有统计学意义(P<0.05)。治疗72 h后,观察组乳酸、C反应蛋白水平低于对照组,差异有统计学意义(P<0.05)。观察组机械通气时间、重症监护室住院时间短于对照组,24 h输液量、多器官功能障碍综合征发生率低于对照组,差异有统计学意义(P<0.05);两组24 h去甲肾上腺素用量、28 d病死率比较,差异无统计学意义(P>0.05)。结论:脓毒性休克患者实施重症超声指导下液体复苏联合针对性护理,有利于精准液体管理,可在保障组织灌注充足的同时促进对氧和营养物质的充分利用,改善预后。

Objective:To explore the application effect of fluid resuscitation combined with targeted nursing under the guidance of critical ultrasound in patients with septic shock.Methods:A total of 90 patients with septic shock admitted to Dongtai People's Hospital from January 2019 to January 2022 were selected as the study subjects and they were divided into control group and observation group according to the random number table method,with 45 cases in each group.The control group was given routine fluid resuscitation combined with targeted nursing,and the observation group was given critical ultrasound guidance on the basis of control group.The treatment effect in two groups was compared.Results:After 6,24 and 72 h of treatment,the compliance rate of fluid resuscitation in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05).After treatment,the mean arterial pressure,central venous pressure and cardiac output in the observation group were higher than those in the control group,and the heart rate in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).After 72 h of treatment,the levels of lactic acid and C-reactive protein in the observation group were lower than those in the control group,and the difference was statistically significant(P<0.05).The duration of mechanical ventilation and length of ICU stay in the observation group were shorter than those in the control group,and the incidence of 24-hour infusion volume and multiple organ dysfunction syndrome in the observation group was lower than that in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in the 24-hour norepinephrine dosage and 28-day mortality rate between the two groups(P>0.05).Conclusion:The implementation of fluid resuscitation combined with targeted nursing under the guidance of critical ultrasound for patients with septic shock is conducive to precise fluid management,which can ensure adequate tissue perfusion while improving the full utilization of oxygen and nutrients,and can improve the prognosis.