左室流出道速度时间积分变异度联合下腔静脉塌陷指数重症感染患者容量管理的评估

Evaluation of volume management in critically infected patients with left ventricular outflow velocity time integral variation rate combined with inferior vena cava collapse index

目的探讨左室流出道速度时间积分变异度(△VTI)联合下腔静脉塌陷指数(IVC-CI)对重症感染患者容量管理的评估。方法选取2020年9月至2022年8月本院收治的50例行机械通气治疗的重症感染患者作为研究对象,根据治疗方法的不同分为两组,每组25例。研究组采用床旁超声△VTI联合IVC-CI指导容量管理,对照组采用中心静脉压(CVP)指导容量管理。比较两组最初6 h早期目标导向治疗(EGDT)达标率、补液前后IVC-CI、△VTI水平、液体管理指标[补液24 h后、血氧饱和度(SpO_(2))、中心静脉血氧饱和度(ScvO_(2))、肺水肿发生率、急性肾衰竭发生率、机械通气时间、15 d生存率]。结果观察组最初6 h的EGDT达标率为88.00%,明显高于对照组的64.00%,差异有统计学意义(P<0.05)。补液24 h后,两组IVC-CI、△VTI水平均低于补液前,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组补液24 h后心率慢于对照组,SpO_(2)、ScvO_(2)、15 d生存率均高于对照组,肺水肿、急性肾衰竭发生率均低于对照组,机械通气时间短于对照组,差异有统计学意义(P<0.05)。结论△VTI联合IVC-CI可有效评估机械通气治疗重症感染患者容量反应性,可有效避免容量过负荷,提升临床疗效,值得临床推广应用。

Objective To explore the evaluation of volume management in critically infected patients with left ventricular outflow velocity time integral variation rate(△VTI)combined with inferior vena cava collapse index(IVC-CI).Methods 50 patients with severe infection who received mechanical ventilation treatment in our hospital from September 2020 to August 2022 were selected as research subjects,and they were divided into two groups according to different treatment methods,with 25 cases in each group.The observation group was guided by bedside ultrasound△VTI combined with IVC-CI,and the control group was guided by central venous pressure(CVP).The compliance rate of early goal-directed therapy(EGDT)in the first 6 h,IVC-CI before and after fluid infusion,△VTI level,fluid management indicators(24 h after fluid infusion,oxygen saturation[SpO_(2)],central venous oxygen saturation[ScvO_(2)],incidence of pulmonary edema,incidence of acute renal failure,mechanical ventilation time,15 d survival rate)were compared between the two groups.Results The compliance rate of EGDT in the first 6 h in the observation group was 88.00%,which was significantly higher than 64.00%in the control group,and the difference was statistically significant(P<0.05).After 24 h of fluid infusion,the IVC-CI and△VTI levels of the two groups were lower than those before fluid infusion,and the observation group was higher than the control group,and the difference was statistically significant(P<0.05).After 24 h of fluid supplementation heart rate of observation group was slower than that of control group,the survival rate of SpO_(2),ScvO_(2) and 15 d survival rate were higher than that of control group,the incidence of pulmonary edema and acute kidney failure were lower than that of control group,and the mechanical ventilation time was shorter than that of control group,and the difference was statistically significant(P<0.05).Conclusion△VTI combined with IVC-CI can effectively evaluate the volume responsiveness of patients with severe infection treated by mechanical ventilation,effectively avoid volume overload,and improve the clinical efficacy,which is worthy of clinical application.