三级水平精细化容量管理在重症患者CRRT治疗中的应用效果观察

目的观察三级水平精细化容量管理在重症患者连续肾脏替代治疗(CRRT)的应用效果。方法选取2020年1月至2022年1月本院急诊重症监护室收治的CRRT治疗患者156例,采用随机数字法将患者分为观察组与对照组,各78例。观察组CRRT治疗过程中执行三级水平精细化容量管理,对照组CRRT治疗过程中执行常规容量管理方法。比较两组患者CRRT治疗时间、升压药使用时间、机械通气时间、EICU入住时间及治疗前后的相关指标。结果两组患者机械通气时间和EICU入住时间比较,差异无统计学意义(P>0.05)。与对照组相比,观察组CRRT期间升压药物使用时间更少(P<0.05),CRRT治疗时间更少(P<0.05)。治疗第5天时观察组中心静脉压和血乳酸值均明显低于对照组(P<0.05),观察组平均动脉压明显高于对照组(P<0.05)。结论三级水平精细化容量管理方案虽未减少患者EICU入住时间,但有助于尽快纠正CRRT患者休克状态,且可缩短患者CRRT治疗时间,降低重症患者CRRT治疗费用,具有临床推广价值。

Objective To observe the application effect of three-level precision volume management in continuous renal replacement therapy(CRRT)for critically ill patients.Methods A total of 156 patients who underwent CRRT treatment in the emergency intensive care unit(EICU)of our hospital from January 2020 to January 2022 were selected.The patients were divided into the observation group and the control group with 78 cases in each group by random number.In the observation group,three-level refined volume management was performed during CRRT treatment,where doctors selected appropriate hemodynamic monitoring methods to evaluate the patient's volume status,set safe volume values and hourly liquid balance targets for CRRT treatment,and whether the volume index touched the upper or lower limit of the volume safety value was closely observed.The fluid balance target and the net dehydration rate of CRRT treatment were dynamically adjusted.In the control group,conventional volume management was performed during the treatment of CRRT,that is,the overall goal of fluid balance during the treatment cycle was set according to the volume status of the patients,and the net dehydration rate was set according to the total intake and outflow of the patients during the treatment cycle.Results There was no significant statistical difference between the two groups in terms of mechanical ventilation time and EICU stay time(P>0.05).Compared with the control group,the observation group had fewer days of vasopressor use during CRRT(P<0.05)and fewer days of required CRRT treatment(P<0.05).On the fifth day of treatment,both central venous pressure and blood lactate values of the observation group were significantly lower than those of the control group(P<0.05),and the mean arterial pressure was significantly higher than that of the control group(P<0.05).Conclusion Although the three-level precision volume management plan does not reduce the number of EICU stay days,it helps to quickly correct the shock state of CRRT patients and reduced the treatment time of CRRT.This results in a reduction in the treatment cost of CRRT for critically ill patients,indicating potential for clinical promotion.