| 汤文杰,叶高峰,温兴杰,倪玲坚,黄丽.超声心动图在老年感染性休克液体复苏中的应用研究[J].中国临床保健杂志,2018,21(4):501-504. |
| 超声心动图在老年感染性休克液体复苏中的应用研究 |
| Study of the transthoracic echocardiography in the fluid resuscitation of elderly patients with septic shock |
| 投稿时间：2018-02-27 |
| DOI：10.3969/J.issn.1672-6790.2018.04.017 |
| 中文关键词: 休克,脓毒性 超声心动描记术 腔静脉,下 老年人 |
| 英文关键词: Shock,septic Echocardiography Vena cava,inferior Aged 〖FL |
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| 中文摘要: |
| 目的 探讨超声心动图(TTE)指导老年感染性休克患者液体复苏中的应用价值。方法 选择明确诊断为感染性休克的96例患者(年龄>60岁),采用随机数字表法分为全心舒张末期容积指数组(GEDVI组)和下腔静脉膨胀指数组(dIVC组)。GEDVI组以PiCCO推荐液体管理方案进行液体复苏,dIVC组以dIVC阈值18%为临界点进行液体复苏,当容量无反应时,加用多巴酚丁胺强心治疗。于确诊后0 h、6 h、24 h,记录心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心脏指数(CI)、急性生理与慢性健康评分(APACHE)Ⅱ评分、乳酸清除率、GEDVI、dIVC。比较两组液体入量差异,及多巴酚丁胺针治疗介入时间、ICU住院时间、28 d死亡率差异。结果 两组6 h液体复苏达标率差异无统计学意义,24 h液体复苏达标率dIVC组高于GEDVI组(68.5%比50.7%,P=0.030)；dIVC组6h(2468.85±326.20)mL、24 h(4738.60±580.35)mL液体入量均显著少于GEDVI组6 h(2896.57±445.68)mL、24 h(5810.30±890.45)mL,差异有统计学意义(P=0.019、P=0.027)；dIVC组应用多发酚丁胺介入时间早于GEDVI组[(2.28±0.69)h比(3.85±1.47)h,P=0.032]；但两组ICU住院时间、28 d死亡率差异无统计学意义。结论 超声心动图测量下腔静脉膨胀指数指导老年感染性休克液体复苏治疗,有助于减少液体入量,适时介入强心药物纠正心肌抑制,减少容量过负荷并发症。 |
| 英文摘要: |
| Objective To investigate the value of fluid resuscitation strategy in elderly patients with septic shock by transthoracic echocardiography(TTE),combined with the parameters of pulse indicator continuous cardiac output(PiCCO).Methods 96 septic shock patients in Intensive Care Unit (age≥60 years) were divided into the global end-diastolic volume index group(GEDVI group) and the Collapsible index of inferior vena cava group(dIVC group).GEDVI group recommended by PiCCO fluid management for fluid resuscitation;fluid responsiveness was defined as≥18% increase in dIVC after liquid loading,the dobutamine injection were used when no reaction.The hemodynamic parameters including Heart rate(HR),mean artery pressure(MAP),central venous pressure(CVP),the cardiac index (CI),APACHE Ⅱ score,clearance rate of lactic,GEDVI and dIVC were measured by PiCCO and/or TTE after 0 h,6 h,24 h liquid loading.Fluid intake,dobutamine intervention time,hospitalization of intensive care unit and the mortality rates of 28-day were compared between two groups.Results In the dIVC group,the 24 h targeting rate was higher than that of the GEDVI group(68.5% vs 50.7%,P=0.030),the fluid intake volumes at 6h and 24h were lowered than those of the GEDVI group[(2468.85±326.20)mL vs (2896.57±445.68)mL,P=0.019;(4738.60±580.35)mL vs(5810.30±890.45)mL,P=0.027],and the dobutamine intervention time was earlier than GEDVI group[(2.28±0.69)h vs(3.85±1.47)h,P=0.032].Yet,there was no effect on the 6h targeting rate.There were no differences in hospitalization time of intensive care unit and 28-Day mortality between two groups.Conclusion Transthoracir echocardiography(TTE) is helpful for fluid resuscitation strategy in elderly patients with septic shock in reducing fluid intake,timely intervening cardiac agents to correct cardiac depression and reducing capacity overload complications. |
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