床旁超声指导脓毒症合并心肌抑制患者液体复苏的应用价值研究

Study on application value of bedside ultrasound-guided fluid resuscitation in sepsis complicated with myocardial depression

目的探讨床旁超声指导脓毒症合并心肌抑制患者液体复苏的应用价值。方法选择50例脓毒症合并心肌抑制患者进行研究,采用床旁超声指导进行液体复苏,比较液体复苏前后患者脓毒症相关性器官功能衰竭评价(SOFA)评分、呼气末下腔静脉变异度(VIVC)、左心室射血分数(LVEF)、心排血量(CO)、肺超声B线积分、心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、乳酸清除率(LCR);统计治愈率、需持续肾脏替代治疗率及28 d病死率。结果液体复苏后患者SOFA评分(5.24±0.45)分、肺超声B线积分(15.27±2.03)分均显著低于液体复苏前的(10.56±1.13)、(18.95±4.03)分,VIVC(13.62±3.25)%小于液体复苏前的(19.95±4.22)%,LVEF(52.03±8.91)%、CO(5.98±1.25)L/min显著高于液体复苏前的(38.71±6.52)%、(5.22±1.05)L/min,差异有统计学意义(P<0.05)。液体复苏后患者HR(98.03±16.27)次/min显著低于液体复苏前的(108.44±15.53)次/min,MAP(84.12±14.61)mm Hg(1 mm Hg=0.133 kPa)、CVP(10.24±2.36)mm Hg、LCR(50.36±10.39)%显著高于液体复苏前的(67.15±10.26)mmHg、(8.62±2.27)mmHg、(8.45±2.23)%,差异有统计学意义(P<0.05)。50例患者治愈24例,治愈率48.00%,需持续肾脏替代治疗17例,治疗率34.00%,28 d病死9例,病死率18.00%。结论床旁超声指导脓毒症合并心肌抑制患者液体复苏的应用价值较高,值得推广。

Objective To discuss the application value of bedside ultrasound-guided fluid resuscitation in sepsis complicated with myocardial depression.Methods 50 patients with sepsis complicated with myocardial depression were studied,and bedside ultrasound was used to guide fluid resuscitation.The score of sepsisrelated organ failure assessment(SOFA),variability index of inferior vena cava(VIVC),left ventricular ejection fraction(LVEF),cardiac output(CO)and lung ultrasound B-line integralbefore and after fluid resuscitation,heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),lactate clearance rate(LCR)were compared before and after fluid resuscitation;the cure rate,rate of continuous renal replacement therapy and the 28-d mortality rate were calculated.Results After fluid resuscitation,SOFA score of(5.24±0.45)points and lung ultrasound B-line integral of(15.27±2.03)points of patients were significantly lower than those of(10.56±1.13)and(18.95±4.03)points before fluid resuscitation;VIVC of(13.62±3.25)%of patients was lower than that of(19.95±4.22)%before fluid resuscitation;LVEF of(52.03±8.91)%and CO of(5.98±1.25)L/min of patients were significantly higher than those of(38.71±6.52)%and(5.22±1.05)L/min before fluid resuscitation;the differences were statistically significant(P<0.05).After fluid resuscitation,HR of(98.03±16.27)beats/min of patients was significantly lower than that of(108.44±15.53)beats/min before fluid resuscitation;patients had MAP of(84.12±14.61)mm Hg(1 mm Hg=0.133 kPa),CVP of(10.24±2.36)mm Hg and LCR of(50.36±10.39)%,which were significantly higher than those of(67.15±10.26)mm Hg,(8.62±2.27)mm Hg and(8.45±2.23)%before fluid resuscitation;the differences were statistically significant(P<0.05).Of the 50 patients,24 cases were cured,and the cure rate was 48.00%;17 patients required continuous renal replacement therapy,and the treatment rate was 34.00%;9 patients died within 28 d,and the mortality rate was 18.00%.Conclusion Bedside ultrasound guided-fluid resuscitation has high application value in patients with sepsis complicated with myocardial inhibition and is worth popularizing.