超声与脉搏指数连续心输出量在监测脓毒症急性肾损伤的疗效对比

Comparison of the Efficacy of Ultrasound and Pulse-Indicated Contour Cardiac Output in Monitoring Sepsis with Acute Kidney Injury

目的 比较床旁超声与脉搏指数连续心输出量(PICCO)动态监测,在脓毒症急性肾损伤(AKI)采用连续性肾脏替代治疗(CRRT)方面的疗效。方法 选取2021年11月至2023年4月广州中医药大学东莞医院ICU收治的脓毒症并发AKI患者60例为研究对象,按照随机数字表法分为观察组和对照组,每组30例。观察组运用床旁超声技术进行下腔静脉管径的测定,对照组应用PICCO技术进行血流动力学监测,分别指导脓毒症AKI患者CRRT过程脱水速度及出入液体正负平衡,比较两组CRRT前、CRRT 24 h后的血肌酐(Scr)、尿素(Urea)、血乳酸(lac)、24 h出入量数据。采用序贯性器官功能衰竭评价(SOFA)评分和急性生理学及慢性健康状况(APACHEⅡ)评分,评价两组预后情况。结果 CRRT 24 h后,观察组Scr、Urea、lac指标均低于对照组(P<0.05);观察组24 h出入量高于对照组(P<0.05);两组SOFA评分和APACHEⅡ评分均低于CRRT前(P<0.05),且观察组的分值均低于对照组(P<0.05)。结论 对于脓毒症并发AKI患者,床旁超声在CRRT过程的液体管理中具有无创、实时动态监测、成像准确度高、图像质量好、可重复性强等优点,而PICCO的准确度优于床旁超声。二者各有优势,在临床操作时应根据实际情况选择合适的操作。

Objective To compare the efficacy of bedside ultrasound and pulse-indicated contour cardiac output(PICCO)dynamic monitoring in guiding continuous renal replacement therapy(CRRT)for sepsis patients with acute kidney injury(AKI).Methods A total of 60 patients with sepsis complicated with AKI admitted to the Intensive Care Unit of Dongguan Hospital of Guangzhou University of Chinese Medicine from November 2021 to April 2023 were selected as the research objects.The patients were randomly assigned into two groups,namely the observation group(n=30)and the control group(n=30).Guided by bedside ultrasound(for the measurement of the diameter of inferior vena cava)in the observation group and by PICCO(for hemodynamic monitoring)in the control group,the rate of dehydration as well as the positive and negative fluid balance during CRRT were carefully regulated.The serum creatinine(Scr),urea(Urea),blood lactic acid(lac)and 24 h fluid intake and output data of the two groups before and 24 h after CRRT were compared.Acute Physiology and Chronic Health Evaluation(APACHEⅡ)score and Sequential Organ Failure Assessment(SOFA)score were used to evaluate the prognosis of patients in both groups.Results After 24 h of CRRT treatment,the serum Scr,Urea and lac in the observation group were lower than those in the control group(P<0.05).The 24 h fluid intake and output in the observation group were higher than those in the control group(P<0.05).The APACHEⅡand SOFA scores in both groups were lower than those before CRRT(P<0.05),and those in the observation group were lower than those in the control group(P<0.05).Conclusion In the liquid management of CRRT for patients with sepsis complicated with AKI,bedside ultrasound has advantages such as non-invasive,real-time dynamic monitoring,high imaging accuracy,good image quality,and strong repeatability,while the accuracy of PICCO is better than that of bedside ultrasound.Therefore,each has its own advantages,and the appropriate technology should be selected according to the actual situation in clinical operation.