河北医科大学学报

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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

  

  1. 河北省沧州中西结合医院东院区重症医学科,河北 沧州 061000
  • 出版日期:2017-01-25 发布日期:2017-02-08
  • 作者简介:张博(1980-),男,河北沧州人,河北省沧州中西结合医院主治医师,医学硕士,从事危重症诊治研究。

Clinical study of hemodynamic monitoring in patients with septic shock by bedside ultrasound

  1. Department of Intensive Care Unit, Chinese and Western medicine hospital, Cangzhou, Hebei province Cangzhou 061000, China
  • Online:2017-01-25 Published:2017-02-08

摘要: [摘要]〓
〖HTH〗目的〖HTSS〗〖KG*2〗探讨床旁超声在感染性休克患者血流动力学监测中的应用价值。
〖HTH〗方法〖HTSS〗〖KG*2〗86例进入ICU治疗的感染性休克患者依据随机数字表法分为2组。对照组采用脉搏指示连续心排血量(pulse indicator continous cardiac output,PICCO)监测血流动力学指标并指导患者进行补液治疗,观察组应用床旁超声监测指标并指导患者进行补液治疗,比较2组治疗6 h 时心率(heart rate,HR)、中心静脉压(central venous pressure,CVP)、平均动脉压(mean arterial pressure,MAP)、血乳酸、尿量、血管活性药物评分、急性生理学及慢性健康状况Ⅱ(acute physiology and chronic health evaluation Ⅱ,APACHEⅡ)评分、输液量、用药量以及机械通气时间、ICU入住时间、28 d病死率。PICCO和床旁超声监测的血流动力学指标差异,并比较不同指导方式治疗效果及预后。
〖HTH〗结果〖HTSS〗〖KG*2〗2组治疗前后SV、CO和CI差异均无统计学意义(P>005);2组在治疗6 h 时HR、 CVP 、 MAP 、血乳酸、尿量、血管活性药物评分、APACHEⅡ评分、输液量、多巴酚丁胺和去加肾上腺素用量差异均无统计学意义(P>005);2组机械通气时间、ICU入住时间和28 d病死率差异均无统计学意义(P>005)。
〖HTH〗结论〖HTSS〗〖KG*2〗床旁超声具有便捷、无创和实时监测等优点,可用于感染性休克患者血流动力学状态实时监测和指导液体复苏,具有较好的应用价值。

关键词: 休克, 脓毒性, 床旁超声, 血流动力学

Abstract: [Abstract]Objective〖HTSS〗〓To evaluate the value of bedside ultrasound in patients with septic shock hemodynamic monitoring.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Eightysix cases shock patients in ICU were randomly divided into two groups:the control group using pulse indicating continuous cardiac output(PICCO) monitoring technology, monitoring indicators to guide patients to rehydration treatment, observation group using bedside ultrasound monitoring indicators to guide patients to rehydration treatment. The hemodynamics parameters measured by different measurement mode and the treatment effect as well as prognosis of different guiding methods were compared.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓There was no difference in HR, CVP, MAP, blood lactate levels, urine output, vasoactive drugs score, APACHEⅡscore after treatment 6 h between two groups(P>005). There was no significant difference in CI, CO and SV between the 2 groups before and after treatment(P>005). There was no difference in 6h infusion volume, the amounts of dobutamine and norepinephrine in two groups(P>005). After ICU treatment, SV, CO and CI in the 2 groups were significantly higher than those before entering the ICU(P<005), but there was no significant difference between the 2 groups(P>005). There was no difference in mechanical ventilation, ICU stay time in two groups(P>005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Bedside ultrasound is convenient, noninvasive and realtime monitoring, which can be used for realtime monitoring and prediction of fluid resuscitation in septic shock patients, and has good application value.

Key words: shock, septic;bedside ultrasound, hemodynamics