B超测下腔静脉变异度指导液体复苏对创伤失血性休克患者血乳酸水平、促炎性因子及免疫功能的影响

Effect of Fluid Resuscitation Guided by B-Ultrasound Measurement of Inferior Vena Cava Variability on Blood Lactic Acid Levels,Pro-Inflammatory Factors,and Immune Function in Patients with Traumatic Hemorrhagic Shock

目的:探讨B超测下腔静脉变异度指导液体复苏对创伤失血性休克患者血乳酸水平、促炎性因子及免疫功能的影响。方法:选取我院2020年4月~2023年2月期间攀枝花学院附属医院收治的108例创伤失血性休克患者,按照液体复苏方式的不同将患者分为对照组和观察组,各为54例。对照组接受传统限制性液体复苏治疗,观察组接受B超测下腔静脉变异度指导液体复苏治疗。对比两组临床指标、血乳酸水平、促炎性因子、免疫功能和多器官功能障碍综合征(MODS)、急性呼吸窘迫综合征(ARDS)以及病死率等情况。结果:观察组的输液量、总输血量少于对照组,重症监护室(ICU)住院时间短于对照组(P<0.05)。治疗后,两组血乳酸水平下降,且观察组低于对照组同期(P<0.05)。治疗后,两组肿瘤坏死因子(TNF)-α,白细胞介素(IL)-1β、白细胞介素(IL)-6水平下降,且观察组低于对照组同期(P<0.05)。治疗后,两组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)升高,CD8^(+)下降,且观察组的改善幅度大于对照组同期(P<0.05)。两组MODS、ARDS、病死率组间对比未见明显差异(P>0.05)。结论:创伤失血性休克患者在B超测下腔静脉变异度指导液体复苏,其促炎性因子、血乳酸水平及免疫功能可得到显著改善,有助于促进患者康复。

Objective:To explore the effect of fluid resuscitation guided by B-ultrasound measurement of inferior vena cava variability on blood lactic acid levels,pro-inflammatory factors,and immune function in patients with traumatic hemorrhagic shock.Methods:108 patients with traumatic hemorrhagic shock who were admitted to the Affiliated Hospital of Panzhihua University from April 2020 to February 2023 were selected,according to the different methods of fluid resuscitation,the patients were divided into control group and observation group,with 54 cases each.The control group was treated with traditional restricted fluid resuscitation,and the observation group was treated with B-ultrasonography to guide fluid resuscitation.Clinical indicators,blood lactic acid levels,pro-inflammatory factors,immune function and multiple organ dysfunction syndrome(MODS),acute respiratory distress syndrome(ARDS)and mortality were compared in the two groups.Results:The infusion volume and total blood transfusion volume in the observation group were less than those in the control group,and the hospitalization time in the intensive care unit(ICU)was shorter than that in the control group(P<0.05).After treatment,the blood lactic acid levels of the two groups decreased,and the observation group was lower than the control group during the same period(P<0.05).After treatment,the tumor necrosis factor(TNF)-α,interleukin(IL)-1βand interleukin(IL)-6 levels in the two groups decreased,and the observation group was lower than the control group during the same period(P<0.05).After treatment,CD3^(+),CD4^(+),CD4^(+)/CD8^(+)in the two groups increased,and CD8^(+)decreased,and the improvement range in the observation group was greater than that in the control group during the same period(P<0.05).There were no significant differences in MODS,ARDS and mortality between the two groups(P>0.05).Conclusion:Patients with traumatic hemorrhagic shock can receive fluid resuscitation guided by the variability of the vena cava measured by ultrasound,and their pro-inflammatory factors,blood lactic acid levels,and immune function can be significantly improved,which helps to promote patient recovery.