动态床旁超声IVC及变异率联合CVP在脓毒症休克患者液体复苏中的监测价值

doi:10.3969/j.issn.1006-6233.2024.03.019

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摘要 目的:探讨动态床旁超声下腔静脉(IVC)及变异率联合中心静脉压(CVP)在脓毒症休克患者液体复苏中的监测价值。方法:选取脓毒症休克患者92例,按随机数表法分为观察组(46例)和对照组(46例)。对照组以CVP监测为依据指导液体复苏治疗,观察组以动态床旁超声IVC及变异率联合CVP监测为依据指导液体复苏治疗。比较两组治疗前、治疗72h的血流动力学参数[心率(HR)、MAP、CVP、乳酸(LAC)],病情程度[急性生理与慢性健康评分(APACHE Ⅱ)、序贯器官衰竭评分(SOFA)];统计患者24h复苏液体量、ICU住院时间,治疗6h、24h、72h复苏达标率,28d病死率。结果:治疗后,两组HR、LAC均较治疗前下降,且观察组低于对照组,两组MAP、CVP均较治疗前上升,且观察组高于对照组(P<0.05)。治疗后,两组APACHE Ⅱ评分、SOFA评分均较治疗前下降,且观察组低于对照组(P<0.05)。观察组复苏液体量、ICU住院时间均低于对照组(P<0.05)。治疗72h时,观察组复苏达标率高于对照组(P<0.05)。两组28d病死率比较,差异无统计学意义(P>0.05)。结论:在动态床旁超声IVC及变异率联合CVP监测下对脓毒症休克患者进行液体复苏,能改善血流动力学,减少复苏液体量,缩短ICU住院时间,提高复苏达标率,促进病情转归。

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关键词 ：脓毒症休克, 液体复苏, 床旁超声, 中心静脉压

Abstract：Objective: To investigate the value of dynamic bedside ultrasound inferior vena cava (IVC) and variability combined with central venous pressure (CVP) for monitoring fluid resuscitation in patients with septic shock.Methods: Ninety-two patients with septic shock were selected and divided into observation group (46 cases) and control group (46 cases) according to random number table method. The control group was guided by liquid resuscitation therapy based on CVP monitoring, and the observation group was guided by dynamic bedside ultrasound IVC and variability rate combined with CVP monitoring. The hemodynamic parameters [heart rate (HR), MAP, CVP, lactic acid (LAC)] the degree of condition [acute physiology and chronic health score (APACHE Ⅱ), sequential organ failure score (SOFA)] of the two groups before treatment and 72h of treatment; statistic patients' 24h resuscitation fluid volume, ICU hospitalization time, resuscitation attainment rate of 6h, 24h and 72h of treatment, 28d morbidity and mortality rates were compared. Results: After treatment, HR and LAC of both groups decreased compared with the pre-treatment period, and the observation group was lower than the control group, and MAP and CVP of both groups increased compared with the pre-treatment period, and the observation group was higher than the control group (P<0.05). After treatment, APACHE Ⅱ score and SOFA score of both groups decreased compared with the pre-treatment, and the observation group was lower than the control group (P<0.05). The amount of resuscitation fluid and ICU hospitalization time of the observation group were lower than those of the control group (P<0.05). At 72h of treatment, the resuscitation compliance rate of the observation group was higher than that of the control group (P<0.05). Comparing the 28d morbidity and mortality rates of the two groups, the difference was not statistically significant (P>0.05). Conclusion: Fluid resuscitation of septic shock patients under dynamic bedside ultrasound IVC and variability combined with CVP monitoring improves hemodynamics, reduces the volume of resuscitated fluids, shortens ICU length of stay, improves resuscitation attainment, and promotes regression.

Key words： Sepsis shock Fluid resuscitation Bedside ultrasound Central venous pressure

基金资助:黔南民族医学高等专科学校科研基金项目,(编号:qnyz202036);贵州省卫生健康委科学技术基金项目,(编号:gzwkj2023-111)

通讯作者: 刘娟

引用本文:

刘志远, 杨桂才, 王春, 顾奕, 顾博, 吴明红, 刘娟. 动态床旁超声IVC及变异率联合CVP在脓毒症休克患者液体复苏中的监测价值[J]. 河北医学, 2024, 30(3): 457-461.
LIU Zhiyuan, YANG Guicai, WANG Chun, et al. Value of Dynamic Bedside Ultrasound IVC and Variability Rate Combined with CVP in Monitoring Fluid Resuscitation of Septic Shock Patients. HeBei Med, 2024, 30(3): 457-461.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2024.03.019 或 http://www.hbyxzzs.cn/CN/Y2024/V30/I3/457

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