文献类型：期刊文献

中文题名：重症超声指导下的早期液体复苏治疗对感染性休克患者临床结局的影响

英文题名：Effects of early fluid resuscitation based on critical ultrasound on clinical outcomes of patients with septic stock

作者：邢玲玲[1];徐飞[1];王敏[1];游晖[2];谷春苗[1];孟德莉[1]

机构：[1]绍兴文理学院附属医院超声科,浙江绍兴312000;[2]绍兴文理学院附属医院EICU,浙江绍兴312000

年份：2022

卷号：32

期号：20

起止页码：3067

中文期刊名：中华医院感染学杂志

外文期刊名：Chinese Journal of Nosocomiology

收录：CSTPCD、、北大核心、CSCD、北大核心2020、CSCD_E2021_2022

基金：浙江省教育厅科研基金资助项目(Y202043221)。

语种：中文

中文关键词：感染性休克;早期液体复苏治疗;重症超声指导;临床结局;影响

外文关键词：Septic shock;Early fluid resuscitation;Critical ultrasound;Clinical outcome;Effect

中文摘要：目的探讨重症超声指导下的早期液体复苏治疗对感染性休克患者临床结局的影响。方法回顾性分析2019年3月-2021年3月绍兴文理学院附属医院收治的77例行早期液体复苏治疗的感染性休克患者,根据不同的监测指导感染性休克患者早期液体复苏治疗的方法分为研究组(n=39)和对照组(n=38),对照组采用脉搏指示连续心排血量(PICCO)指导液体复苏治疗,研究组在对照组的基础上联合重症超声指导液体复苏治疗。比较两组患者分别在入组时(0 h)及入组后(6 h、12 h)记录的以下参数:一般血流动力学参数指标、研究组患者各时间点超声参数、组织灌注及氧代谢指标、6 h、12 h复苏液体量、尿量及液体正平衡量。比较两组患者临床结局。采用受试者工作特征(ROC)曲线评价PICCO参数每搏量变异(SVV)单独检测以及SVV联合下腔静脉(IVC)呼吸变异指数预测液体复苏容量反应性的效能。结果T6、T12两个时间点两组患者的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)指标均高于T0时间点(P<0.05);T6、T12两个时间点两组患者的静脉血氧饱和度(ScvO_(2))均升高,乳酸(Lac)均降低(P<0.05);T6、T12两个时间点两组患者的ITBVI、CO、CI、EVLWI、SVRI高于T0时间点,SVV指标低于T0时间点;研究组患者的LVEDV、LVEDD、IVC_(max)、IVC_(min)、LVEF、CO高于T0时间点,IVC呼吸变异指数低于T0时间点(P均<0.05);研究组患者T6和T12时间点复苏液体量及液体正平衡量均低于对照组,而尿量高于对照组(P<0.05);SVV、SVV联合IVC呼吸变异指数预测容量反应性的ROC曲线面积分别为0.847、0.899,敏感性分别为89.50%、94.74%,特异性分别为80.00%、85.00%(P<0.05);研究组患者机械通气时间、住院时间短于对照组(P<0.05)。结论重症超声联合PICCO应用于早期液体复苏治疗感染性休克患者,能有效评估患者的心功能状态,降低并发症的发生风险,且能改善部分临床结局,增加液体复苏治疗的全面性和安全性。

外文摘要：OBJECTIVE To explore the effects of early fluid resuscitation based on critical ultrasound on clinical outcomes of patients with septic shock.METHODS A retrospective analysis was performed on the 77 patients with septic shock undergoing early fluid resuscitation in the Affiliated Hospital of Shaoxing University of Arts and Sciences between Mar.2019 and Mar.2021.According to different early fluid resuscitation methods,they were divided into study group(n=39,fluid resuscitation guided by critical ultrasound on basis of control group)and control group[n=38,fluid resuscitation guided by pulse-indicated continuous cardiac output(PICCO)].The general hemodynamic parameters at enrollment(0 h)and after enrollment(6 h,12 h)between the two groups,ultrasound parameters,tissues perfusion and oxygen metabolism indexes at each time point,resuscitation fluid volume,urine volume and positive fluid balance volume at 6 h and 12 h in study group,and clinical outcomes between the two groups were compared.The predictive efficiency of stroke volume variability(SVV)alone and SVV combined with respiratory variation index(IVC)for fluid resuscitation volume responsiveness was evaluated by receiver operating characteristic(ROC)curves.RESULTS The systolic blood pressure(SBP),diastolic blood pressure(DBP)and mean arterial pressure(MAP)at T6 and T12 were higher than those at T0 in both groups(P<0.05).At T6 and T12,venous oxygen saturation(ScvO_(2))was increased,while lactic acid(Lac)was decreased in both groups(P<0.05).ITBVI,CO,CI,EVLWI and SVRI at T6 and T12 were higher than those at T0,while SVV was lower than that at T0 in both groups.In the study group,LVEDV,LVEDd,ivc_(max),ivc_(min),LVEF and CO were higher than t0 time point,and IVC respiratory variation index was lower than T0 time point(all P<0.05).At T6 and T12,resuscitation fluid volume and positive fluid balance volume in study group were lower than those in control group,while urine volume was more than that in control group(P<0.05).The area under the ROC curve(AUC),sensitivity and specificity of SVV alone and SVV combined with IVC for predicting volume responsiveness were(0.847,0.899),(89.50%,94.74%)and(80.00%,85.00%),respectively(P<0.05).The mechanical ventilation time and hospitalization time in study group were shorter than those in control group(P<0.05).CONCLUSION The application of critical ultrasound combined with PICCO in early fluid resuscitation can effectively assess cardiac function,reduce the risk of complications,improve some clinical outcomes,increase the comprehensiveness and safety of fluid resuscitation in patients with septic shock.