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

Abstract
Figure/Table
References
Related Citation (7)

Download: PDF (1213 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

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

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors

Cite this article:

URL:

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

[1] Liu YC,Yao Y,Yu MM,et al.Frequency and mortality of sepsis and septic shock in China:a systematic review and meta analysis[J].BMC Infect Dis,2022,22(1):564.
[2] 师华华,刘天瑜,张彦峰,等.重症超声联合中心静脉血氧饱和度可指导脓毒症休克患者液体复苏治疗[J].内科急危重症杂志,2022,28(5):401-403.
[3] 程涛,谷志寒,韩天勇,等.脓毒症液体复苏终点评估新进展[J].医学研究杂志,2022,51(4):144-147.
[4] 高山,张永.床边下腔静脉超声指标及中心静脉压对脓毒性休克患者容量反应性的预测价值[J].中华全科医学,2021,19(4):581-585.
[5] 中国医师协会急诊医师分会,中国医师协会急诊医师分会循环与血流动力学学组,中华医学会急诊医学分会,等.中心静脉压急诊临床应用中国专家共识(2020)[J].中华急诊医学杂志,2020,29(6):757-764.
[6] Knaus WA,Zimmerman JE,Wagner DP,et al.APACHE-acute physiology and chronic health evaluation:a physiologically based classification system[J].Critical Care Medicine,1981,9(8):591.
[7] Peres BD,Melot C,Lopes FF,et al.The multiple organ dysfunction score (MODS) versus the sequential organ failure assessment (SOFA) score in outcome prediction[J].Intensive Care Medicine,2002,28(11):1619-1624.
[8] 中国医师协会急诊医师分会,中国研究型医院学会休克与脓毒症专业委员会.中国脓毒症/脓毒性休克急诊治疗指南(2018)[J].中国急救医学,2018,38(9):741-756.
[9] 玛依拉·阿扎提,肖克来提·霍加合买提,李吉明,等.基于每搏量变异度的液体复苏方式对脓毒症休克患者组织氧代谢及预后的影响[J].疑难病杂志,2020,12(19):1248-1251.
[10] 孙乾辉,曹加明,孙婷,等.无创超声心排血量监测技术联合被动抬腿试验在老年脓毒症患者液体复苏中的应用[J].浙江医学,2020,42(9):935-938.
[11] 刘辉,李志霞,谢志伟.中心静脉压联合每搏量变异度为目标导向的液体治疗在腹腔镜肝叶切除术中的应用[J].山西医药杂志,2021,50(10):1672-1674.
[12] 王雪婷,高雪花,曹雯,等.血乳酸联合Pcv-aCO₂/Ca-cvO₂及下腔静脉直径扩张指数指导脓毒症休克早期液体复苏治疗的价值[J].中国急救医学,2020,40(8):703-708.
[13] 孟华东,周树生,查渝,等.最适宜下腔静脉宽度指导脓毒症休克患者个体化液体管理的应用价值[J].安徽医科大学学报,2020,55(10):1637-1640.
[14] 刘璐,叶英,杜志强,等.超声监测下腔静脉变异度指导液体复苏对脓毒症休克患者预后的影响[J].中国医刊,2022,57(6):682-686.
[15] 要莉莉,马永峰,张丽,等.超声检查与PiCCO监测指导脓毒症患者早期液体复苏效果的对比研究[J].临床超声医学杂志,2022,24(2):147-150.