超声引导下液体复苏治疗对脓毒症休克患者复苏效果和近期预后的影响

Influence of ultrasound-guided fluid resuscitation therapy on resuscitation effect and short-term prognosis in patients with septic shock

目的探讨超声引导下液体复苏治疗对脓毒症休克患者的复苏效果和近期预后的影响。方法选择2020年1月至2022年1月汉中市人民医院收治的92例脓毒症休克患者作为研究对象,按随机数表法分为观察组(采用超声引导下液体复苏治疗)和对照组(采用常规治疗方法)各46例,复苏后比较两组患者的超声监测结果、血流动力学参数、复苏达标率、氧代谢各项指标、组织灌注和预后情况。结果复苏前,两组患者的下腔静脉最大直径(D_(max))、下腔静脉最小直径(D_(min))、下腔静脉变异度(IVCV)比较差异均无统计学意义(P>0.05);复苏后,观察组患者的IVCV为(10.12±1.47)%,明显低于对照组的(11.93±1.87)%,差异有统计学意义(P<0.05);复苏后,观察组患者的心率为(89.12±13.49)次/min,明显低于对照组的(100.65±19.41)次/min;而收缩压、舒张压、中心静脉压分别为(123.92±13.23)mmHg、(70.47±9.22)mm Hg、(9.98±2.26)cmH_(2)O,明显高于对照组的(117.97±12.31)mmHg、(65.89±8.17)mmHg、(8.85±2.31)cmH_(2)O,差异均有统计学意义(P<0.05);治疗后,观察组患者在6 h、12 h、24 h的复苏率分别为26.09%、52.17%、76.09%,明显高于对照组的8.70%、30.43%、52.17%,差异均有统计学意义(P<0.05);复苏后,观察组患者的氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、血氧饱和度(ScvO_(2))、二氧化碳分压差(Pcv-aCO_(2))分别为(96.42±0.11)mmHg、(34.49±0.23)mm Hg、(66.12±0.49)%、(1.44±0.23)mmol/L,明显高于对照组的(95.23±0.24)mm Hg、(34.48±0.21)mmHg,(63.65±0.41)%、(1.21±0.31)mmol/L,差异均有统计学意义(P<0.05);复苏后,观察组患者血乳酸、动脉血CO_(2)分压分别为(5.09±0.23)mmol/L、(10.12±0.49)mmHg,明显低于对照组的(6.08±0.21)mmol/L、(12.65±0.41)mmHg,差异均有统计学意义(P<0.05);复苏后,观察组患者血管外肺水指数、ICU住院时间、28 d病死率分别为(10.09±0.23)mL/kg、(11.22±1.39)d、4.35%,明显低(短)于对照组的(11.08±0.21)mL/kg、(14.31±1.47)d、21.74%,差异均有统计学意义(P<0.05)。结论超声引导下液体复苏治疗能够改善脓毒症休克患者的血流动力学参数,提高复苏达标率,改善患者氧代谢,具有临床应用价值。

Objective To investigate the effect of fluid resuscitation therapy guided by ultrasound on the resuscitation effect and short-term prognosis in patients with septic shock.Methods A total of 92 patients with septic shock admitted to Hanzhong People's Hospital from January 2020 to January 2022 were selected as research objects.According to random number table method,they were divided into an observation group(receiving ultrasound-guided fluid resuscitation treatment)and a control group(receiving conventional treatment),with 46 patients in each group.After resuscitation,ultrasound monitoring results,hemodynamic parameters,resuscitation standard rate,oxygen metabolism indexes,tissue perfusion,and prognosis were compared between the two groups.Results Before resuscitation,there were no significant differences in maximum diameter of inferior vena cava(D_(max)),minimum diameter of inferior vena cava(D_(min))and variation of inferior vena cava(IVCV)between the two groups(P>0.05).After resuscitation,the IVCV in the observation group was(10.12±1.47)%,which was significantly lower than(11.93±1.87)%in the control group(P<0.05).After resuscitation,the heart rate in the observation group was(89.12±13.49)beats/min,which was significantly lower than(100.65±19.41)beats/min in the control group(P<0.05);the systolic,diastolic and central venous pressures in the observation group were(123.92±13.23)mmHg,(70.47±9.22)mmHg,(9.98±2.26)cmH_(2)O,respectively,which were significantly higher than(117.97±12.31)mmHg,(65.89±8.17)mmHg,(8.85±2.31)cmH_(2)O in the control group(P<0.05).After treatment,the resuscitation rates of observation group at 6 h,12 h,and 24 h were 26.09%,52.17%,and 76.09%,respectively,which were significantly higher than 8.70%,30.43%,and 52.17%in the control group(P<0.05).After resuscitation,the oxygen partial pressure(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),blood oxygen saturation(ScvO_(2)),and the partial pressure difference of carbon dioxide(Pcv-aCO_(2))in the observation group were(96.42±0.11)mmHg,(34.49±0.23)mmHg,(66.12±0.49)%,and(1.44±0.23)mmol/L,respectively,which were significantly higher than(95.23±0.24)mmHg,(34.48±0.21)mmHg,(63.65±0.41)%,(1.21±0.31)mmol/L in the control group(P<0.05).After resuscitation,blood lactate and arterial blood CO_(2) in the observation group were(5.09±0.23)mmol/L and(10.12±0.49)mmHg,which were significantly lower than(6.08±0.21)mmol/L and(12.65±0.41)mmHg in the control group(P<0.05).After resuscitation,the extravascular pulmonary water index,length of ICU stay,and 28 d mortality in the observation group were(10.09±0.23)mL/kg,(11.22±1.39)d,and 4.35%,respectively,which were significantly lower(shorter)than(11.08±0.21)mL/kg,(14.31±1.47)d,21.74%in the control group(P<0.05).Conclusion Ultrasound-guided fluid resuscitation therapy can improve the hemodynamic parameters of patients with septic shock,increase the rate of resuscitation compliance,improve the oxygen metabolism of patients,which has significant clinical application value.