重症超声联合被动抬腿试验指导休克患者液体复苏的效果
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摘要
目的探讨应用重症超声联合被动抬腿试验(PLR)指导休克进行液体复苏的临床效果。方法选择2016年10月～2018年10月我院ICU收治的60例休克患者作为研究对象,采用随机数字表法将其分为参照组和试验组,每组各30例。参照组采用中心静脉压(CVP)、平均动脉压、心率、脑钠肽(BNP)、尿量等常规监测血流动力学指标进行液体复苏管理,试验组采用重症超声联合PLR指导液体复苏。比较两组的机械通气时间、ICU滞留时间,并统计比较两组的6 h复苏达标率、肺水肿发生率、院内死亡率等指标。结果试验组机械通气时间及ICU滞留时间均短于参照组,差异有统计学意义(P<0.05)。试验组复苏6 h达标率明显高于参照组,肺水肿发生率低于参照组,差异有统计学意义(P<0.05)。但两组的院内死亡率比较,差异无统计学意义(P>0.05)。结论应用重症超声联合PLR指导休克液体复苏,能提高液体复苏效果,减少肺水肿发生率,缩短患者机械通气时间和ICU滞留时间,有助于改善患者预后。
Objective To investigate the clinical effect of severe ultrasound combined with passive leg lifting test(PLR to guide fluid resuscitation for shock. Methods From October 2016 to October 2018, 60 patients with shock in our hospital ICU were selected as the study objects. They were divided into the reference group and the experimental group according to random digital table method, 30 cases in each group. In the reference group, fluid resuscitation was managed by routine monitoring of hemodynamic indexes such as central venous pressure(CVP), mean arterial pressure, heart rate and brain natriuretic peptide(BNP), urine volume, while in the experimental group, fluid resuscitation was managed by severe ultrasound combined with PLR. The mechanical ventilation time and ICU retention time were observed and compared between the two groups. The 6 h resuscitation rate, the incidence of pulmonary edema and the hospital mortality were compared between the two groups. Results The mechanical ventilation time and ICU retention time in the experimental group were significantly shorter than those in the reference group, and the difference was statistically significant(P<0.05). The rate of 6 h resuscitation in the experimental group was significantly higher than that in the reference group, and the incidence of pulmonary edema was lower than that in the reference group, and the differences were statistically significant(P <0.05). However, there was no significant difference in hospital mortality between the two groups(P>0.05). Conclusion The application of severe ultrasound combined with PLR to direct shock fluid resuscitation can improve the effect of fluid resuscitation, reduce the incidence of pulmonary edema, shorten the mechanical ventilation time and ICU retention time, and help to improve the prognosis of the patients.
Objective To investigate the clinical effect of severe ultrasound combined with passive leg lifting test(PLR to guide fluid resuscitation for shock. Methods From October 2016 to October 2018, 60 patients with shock in our hospital ICU were selected as the study objects. They were divided into the reference group and the experimental group according to random digital table method, 30 cases in each group. In the reference group, fluid resuscitation was managed by routine monitoring of hemodynamic indexes such as central venous pressure(CVP), mean arterial pressure, heart rate and brain natriuretic peptide(BNP), urine volume, while in the experimental group, fluid resuscitation was managed by severe ultrasound combined with PLR. The mechanical ventilation time and ICU retention time were observed and compared between the two groups. The 6 h resuscitation rate, the incidence of pulmonary edema and the hospital mortality were compared between the two groups. Results The mechanical ventilation time and ICU retention time in the experimental group were significantly shorter than those in the reference group, and the difference was statistically significant(P<0.05). The rate of 6 h resuscitation in the experimental group was significantly higher than that in the reference group, and the incidence of pulmonary edema was lower than that in the reference group, and the differences were statistically significant(P <0.05). However, there was no significant difference in hospital mortality between the two groups(P>0.05). Conclusion The application of severe ultrasound combined with PLR to direct shock fluid resuscitation can improve the effect of fluid resuscitation, reduce the incidence of pulmonary edema, shorten the mechanical ventilation time and ICU retention time, and help to improve the prognosis of the patients.
引文
[1]陈俊峰,陈洁,陈惠英.PiCCO监测技术指导液体复苏和EGDT方案指导液体复苏在感染性休克患者中的应用对比[J].中国当代医药,2018,25(4):32-34.
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[6]王洪亮,章志丹,黄伟.拯救脓毒症运动:脓毒症与感染性休克治疗国际指南(2016)的解读与展望[J].中华重症医学电子杂志,2017,3(1):26-32.
[7]吴敬医,张霞,王箴,等.超声心动图评价感染性休克患者液体反应性的临床研究[J].中华危重病急救医学,2014,26(1):36-40.
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[9]冯天娇,李雪蓉,宋长春,等.PICCO在感染性休克液体复苏中的临床指导意义[J].淮海医药,2015,21(5):455-457.
[10]张博,丁开方,杨东星,等.床旁超声在感染性休克患者血流动力学监测中的临床研究[J].河北医科大学学报,2017,38(1):16-19.
[11]Xu CY,Ye HW,Yu FF,et al.Application of Flo Trac/Vigileo system combined with passive leg raising for fluid resuscitation of elderly patients with septic shock[J].J Guiyang Med Coll,2014,18(12):144-145.
[12]许春阳,叶宏伟,冯玉峰,等FloTrac/Vigileo系统联合被动抬腿试验在老年感染性休克患者液体复苏中的应用[J].贵阳医学院学报,2014,39(6):834-837.
[13]赖军华,刘欢,莫松.被动抬腿试验对48例行早期液体复苏的感染性休克患者的容量反应性评价[J].重庆医学,2013,42(1):67-69.
[14]黄小洵,孟繁甦,林冰,等.重症超声指导感染性休克患者早期液体复苏治疗的临床研究[J].深圳中西医结合杂志,2018,19(5):1041-1043.
[15]吕立文,唐宇涛,罗丽,等.感染性休克患者应用重症超声与连续心排血量监测(PiCCO)对比监测指导液体复苏的应用[J].中国医药导刊,2017,19(4):325-326.
[16]黄樱菲,周敦荣,姜悦,等.重症超声联合被动抬腿试验指导感染性休克液体复苏的临床价值[J].齐齐哈尔医学院学报,2017,38(12):1368-1370.
[2]任宏生,蒋进皎,楚玉峰,等.高容量血液滤过对感染性休克患者血管外肺水和肺泡-动脉间氧交换影响的研究[J].中华危重病急救医学,2014,26(9):609-614.
[3]黄磊,张卫星,蔡文训,等.被动抬腿试验预测严重感染和感染性休克患者的容量反应性[J].中华危重病急救医学,2011,23(3):154-157.
[4]中华医学会重症医学分会.成人严重感染与感染性休克血流动力学监测及支持指南(草案)[J].中华危重病急救医学,2007,19(3):129-133.
[5]李文雯,万献尧.感染性休克时液体复苏相关性肺损伤研究进展[J].中国呼吸与危重监护杂志,2012,11(5):510-513.
[6]王洪亮,章志丹,黄伟.拯救脓毒症运动:脓毒症与感染性休克治疗国际指南(2016)的解读与展望[J].中华重症医学电子杂志,2017,3(1):26-32.
[7]吴敬医,张霞,王箴,等.超声心动图评价感染性休克患者液体反应性的临床研究[J].中华危重病急救医学,2014,26(1):36-40.
[8]石朝积,张永辉,李刚,等.被动抬腿联合心脏超声预测容量反应性的临床研究[J].重庆医学,2016,45(26):3646-3649.
[9]冯天娇,李雪蓉,宋长春,等.PICCO在感染性休克液体复苏中的临床指导意义[J].淮海医药,2015,21(5):455-457.
[10]张博,丁开方,杨东星,等.床旁超声在感染性休克患者血流动力学监测中的临床研究[J].河北医科大学学报,2017,38(1):16-19.
[11]Xu CY,Ye HW,Yu FF,et al.Application of Flo Trac/Vigileo system combined with passive leg raising for fluid resuscitation of elderly patients with septic shock[J].J Guiyang Med Coll,2014,18(12):144-145.
[12]许春阳,叶宏伟,冯玉峰,等FloTrac/Vigileo系统联合被动抬腿试验在老年感染性休克患者液体复苏中的应用[J].贵阳医学院学报,2014,39(6):834-837.
[13]赖军华,刘欢,莫松.被动抬腿试验对48例行早期液体复苏的感染性休克患者的容量反应性评价[J].重庆医学,2013,42(1):67-69.
[14]黄小洵,孟繁甦,林冰,等.重症超声指导感染性休克患者早期液体复苏治疗的临床研究[J].深圳中西医结合杂志,2018,19(5):1041-1043.
[15]吕立文,唐宇涛,罗丽,等.感染性休克患者应用重症超声与连续心排血量监测(PiCCO)对比监测指导液体复苏的应用[J].中国医药导刊,2017,19(4):325-326.
[16]黄樱菲,周敦荣,姜悦,等.重症超声联合被动抬腿试验指导感染性休克液体复苏的临床价值[J].齐齐哈尔医学院学报,2017,38(12):1368-1370.