适度液体负平衡在脓毒性休克机械通气患者撤机过程中的应用

目的:观察适度液体负平衡在脓毒性休克机械通气患者撤机过程中的应用价值。方法:纳入 60 例脓毒性休克、接受机械通气治疗患者，随机均分为2组，各30例。2组均接受相似的液体复苏方案，在 血流动力学稳定后，观察组采用适度液体负平衡方案进行液体管理；对照组不限制液体输入量，保持液 体基本平衡或正平衡。观察2组撤机效果及近期预后。结果:观察组一次撤机成功率略高于对照组，但差 异无统计学意义（P＞0.05），观察组首次撤机当日液体平衡量明显低于对照组，机械通气时间、ICU住 院时间明显短于对照组，多器官功能障碍综合征发生率和28 d病死率均明显少于对照组，差异有统计学 意义（P＜0.05）。撤机48 h，观察组动脉氧分压与吸入氧浓度比明显高于对照组；首次撤机和撤机48 h ，观察组平均动脉压、血管外肺水指数、外周血N末端B型利钠肽原低于对照组，以上差异均有统计学意 义（P<0.05）。入院48 h，观察组急性生理学及慢性健康状况评分Ⅱ明显低于对照组，差异有统计学意 义（P＜0.05）。结论:在血流动力学稳定后，以适度液体负平衡方案对脓毒性休克患者进行液体管理， 有助于提升机械通气撤机效果，这可能与该方案能够减轻患者心肺损伤有关。

Application of moderate negative fluid balance in patients with septic shock during weaining from mechanical ventilation

Objective: To observe the value of moderate negative fluid balance in patients with septic shock during weaning from mechanical ventilation. Methods: Sixty cases with septic shock and treated with mechanical ventilation were randomly divided into 2 groups, with 30 cases in each. All patients were treated with similar fluid resuscitation scheme at first, until hemodynamic stability was reached. Then the observation group was treated with moderate negative fluid balance, while the control group maintained liquid balance or was treated with positive equilibrium. The effects of weaning and prognosis in 2 groups were compared. Results: Patients who succeeded at first trail of weaning in the observation group was slightly more than in the control group, but the difference was not statistically significant (P＞0.05). The fluid balance volume at the day of weaning trail in the observation group was much less than that in the control group, duration of mechanical ventilation and ICU hospitalization in the observation group were much shorter, incidence of multiple organ dysfunction syndrome and mortality within 28 days in the observation group were much less, and the differences were statistically significant (P＜0.05). 48 h after weaning trial, partial pressure of oxygen/fraction of inspired oxygen in the observation group was significantly higher than that in the control group. During the first weaning and weaning 48 h, the mean arterial pressure, extra-pulmonary lung water index and the N-terminal B-type natriuretic peptide in peripheral blood were lower than those in the control group. The differences were statistically significant (P <0.05). 48 h after admission, acute physiology and chronic health evaluation II score in the observation group were significantly lower than those in the control group, and the differences were statistically significant (P＜0.05). Conclusion: After reaching hemodynamic stability, moderate negative fluid balance for patients with septic shock can help to improve the mechanical ventilation effect, which may be related to the scheme that can reduce the damage of heart and lung.