液体负平衡及感染管理在重型新型冠状病毒感染急性呼吸窘迫综合征治疗中的临床意义

Clinical significance of negative fluid balance and infection management in the treatment of acute respiratory distress syndrome caused by severe novel coronavirus infection

目的探讨液体负平衡及感染管理在重型新型冠状病毒(新冠病毒)感染急性呼吸窘迫综合征(ARDS)治疗中的临床意义。方法采用回顾性调查研究方法,选择在甘肃中医药大学第三附属医院重症医学科住院并进行无创呼吸机辅助通气的重型新冠病毒感染ARDS患者作为研究对象。所有患者均每日精确统计液体出入量,根据前1 d的出量调整次日患者的液体入量。根据液体负平衡及患者进行治疗、检查操作过程中是否遵守医院感染管理办法,将液体负平衡在200 mL/d以上且严格执行医院感染管理的45例患者作为观察组,液体负平衡不足200 mL/d且未严格执行医院感染管理的48例患者作为对照组。比较两组患者一般资料、脱机成功率、气管插管率、病死率,以及治疗后白细胞计数(WBC)、降钙素原(PCT)、C-反应蛋白(CRP)等实验室指标的差异。结果观察组与对照组性别(男性:51.1%比52.1%)、年龄(岁:66.31±15.92比67.50±13.59)、急性生理学与慢性健康状况评分Ⅱ〔APACHEⅡ(分):18.98±4.81比18.54±4.35〕比较差异均无统计学意义(均P>0.05),说明基线资料均衡,具有可比性。与对照组比较,观察组脱机成功率明显升高〔53.3%(24/45)比31.2%(15/48),P=0.031〕,气管插管率明显降低〔22.2%(10/45)比43.8%(21/48),P=0.028〕,病死率明显降低〔20.0%(9/45)比41.7%(20/48),P=0.024〕,实验室指标WBC、PCT、CRP水平均明显降低〔WBC(×10^(9)/L):8.085±4.136比16.898±7.733,CRP(mg/L):82.827±52.680比150.679±74.625,PCT(μg/L):3.142±2.323比7.539±5.939,均P<0.01〕。结论液体负平衡及感染管理在重型新冠病毒感染ARDS治疗中具有显著性的临床意义。

Objective To explore the clinical significance of negative fluid balance and infection management in the treatment of acute respiratory distress syndrome(ARDS)caused by severe novel coronavirus infection.Methods A retrospective survey was conducted.Patients with ARDS caused by severe novel coronavirus infection who were hospitalized in the department of critical care medicine of the Third Affiliated Hospital of Gansu University of Chinese Medicine and received non-invasive ventilator assisted ventilation were selected as the research objects.The fluid intake and output of all patients were accurately counted every day,and the fluid intake of the next day was adjusted according to the output of the previous day.According to the fluid negative balance,and whether the hospital infection management measures were complied with during the treatment and inspection of the patients,45 patients with a negative fluid balance of more than 200 mL/d and strict management of nosocomial infection were taken as the observation group,and 48 patients with a negative fluid balance of less than 200 mL/d and no strict management of nosocomial infection were taken as the control group.The general data,weaning success rate,endotracheal intubation rate,mortality,as well as laboratory indicators such as white blood cell count(WBC),procalcitonin(PCT),C-reactive protein(CRP)after treatment were compared between the two groups.Results There were no significant differences in gender(male:51.1%vs.52.1%),age(years old:66.31±15.92 vs.67.50±13.59),acute physiology and chronic health evalutionⅡ(APACHEⅡ:18.98±4.81 vs.18.54±4.35)between the observation group and the control group(all P>0.05),indicating that the baseline data were balanced and comparable.Compared with the control group,the weaning success rate of the observation group significantly increased[53.3%(24/45)vs.31.2%(15/48),P=0.031],endotracheal intubation rate significantly decreased[22.2%(10/45)vs.43.8%(21/48),P=0.028],mortality significantly reduced[20.0%(9/45)vs.41.7%(20/48),P=0.024],laboratory indicators WBC,PCT and CRP levels were significantly reduced[WBC(×10^(9)/L):8.085±4.136 vs.16.898±7.733,CRP(mg/L):82.827±52.680 vs.150.679±74.625,PCT(μg/L):3.142±2.323 vs.7.539±5.939,all P<0.01].Conclusion Fluid negative balance and infection management have significant clinical significance in the treatment of severe novel coronavirus infection with ARDS.