床旁超声指导重症脓毒症患者早期液体复苏治疗的临床应用价值分析

目的 探讨床旁超声指导重症脓毒症患者早期液体复苏治疗的临床应用价值。方法 将2018年4月～2019年12月收治的98例重症脓毒症患者作为研究对象,按照液体复苏治疗期间相关指标监测的不同分为对照组(49例)和观察组(49例)。所有患者均接受液体复苏治疗,对照组以脉搏指示剂持续心排血量法(Pulse indicator continuous cardiac output,PICCO)监测患者的血容量指数,观察组在液体复苏期间应用床旁超声对患者的下腔静脉内径进行监测。对比两组患者中心静脉压(Central venous pressure,CVP)、平均动脉压(Mean arterial pressure,MAP)、中心静脉血氧饱和度(Systemic central venous oxygen saturation,ScvO2)指标水平的变化,并比较两组患者液体复苏达标率、液体复苏用量、血管活性药物用量、肺水肿发生情况及28 d病死率。结果 治疗前两组患者的CVP、MAP、ScvO2指标水平对比无统计学意义(P0.05);液体复苏6 h、12 h后两组患者的CVP、MAP、ScvO2指标水平对比也均无统计学意义(P0.05)。观察组患者的液体复苏达标率在液体复苏6 h、24 h、36 h的时间节点均高于对照组,有统计学意义(P0.05)。观察组液体复苏用量少于对照组,有统计学意义(P0.05),观察组血管活性药物用量少于对照组,但对比无统计学意义(P0.05)。观察组液体复苏期间肺水肿发生率低于对照组,有统计学意义(P0.05);两组患者28 d病死率对比无统计学意义(P0.05)。结论 重症脓毒症患者在行早期液体复苏期间采用床旁超声作为参考,能改善患者的血流动力学指标,提高液体复苏的效果,减少复苏时间和液体、药物用量,应用价值高。

Analysis of clinical application value of bedside ultrasound in guiding early fluid resuscitation in patients with severe sepsis

Objective To explore the clinical value of bedside ultrasound in guiding early fluid resuscitation in patients with severe sepsis.Methods A total of 98 patients with severe sepsis admitted from April 2018 to December 2019 were taken as the research object,and were divided into a control group(49 cases) and an observation group(49 cases) according to the different relevant indicators monitoring during the fluid resuscitation treatment.All patients received fluid resuscitation.The pulse indicator continuous cardiac output(PICCO) was used to monitor the patient''s blood volume index in the control group.The bedside ultrasound was used to monitor the inner diameter of the patient''s inferior vena cava during fluid resuscitation in the observation group.The changes of central venous pressure (CVP),mean arterial pressure(MAP),and central venous oxygen saturation(ScvO2) indexes were compared between the two groups.The standard rate of fluid resuscitation,the dosage of fluid resuscitation,the dosage of vasoactive drugs,the incidence of pulmonary edema and the 28 day mortality were compared between the two groups.Results There was no statistically significant difference in the CVP,MAP,ScvO2 index levels between the two groups before treatment (P>0.05).And there was no statistically significant difference in the CVP,MAP,and ScvO2 index levels of the two groups after 6 and 12 hours of fluid resuscitation(P>0.05).The compliance rate of the fluid resuscitation of the observation group was higher than that of the control group at 6 h,24 h and 36 h of fluid resuscitation,with significant difference(P<0.05).The amount of fluid resuscitation in the observation group was less than that in the control group(P<0.05).The amount of vasoactive drugs in the observation group was less than that in the control group,but the difference was not statisticallysignificant (P>0.05).The incidence of pulmonary edema in the observation group during fluid resuscitation was lower than that in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in 28 day mortality between the two groups(P>0.05).Conclusion The use of bedside ultrasound as a reference during early fluid resuscitation in patients with severe sepsis can improve the patient''s hemodynamic indicators,improve the effect of fluid resuscitation,reduce the recovery time and the amount of fluid and drugs,and has high application value.