不同液体复苏量与休克患者预后及并发症的相关性研究

目的探讨不同液体复苏量对休克患者临床预后及并发症的影响。方法收集2018年1月1日至2019年4月30日在安徽医科大学附属安徽省立医院ICU住院的休克患者116例,将患者根据1周液体入量分为3组(1组:<2500 mL,17例;2组:2500~3500 mL,66例;3组:>3500 mL,33例);根据液体平衡量分为4组(A组:<-500 mL,22例;B组:-500~<0 mL,27例;C组:0~500 mL,36例;D组>500 mL,31例)。比较不同液体入量组患者的年龄、性别、APACHEⅡ评分、SOFA评分、氧和指数、BNP、Cr、BUN、LAC、总胆红素水平、ICU死亡率、28 d死亡率、心力衰竭发生率、ICU住院天数、机械通气时间、利尿剂1周内总量;比较不同液体平衡量组患者的ICU死亡率、28 d死亡率;采用韦恩图分析两种分组方法下患者的28 d死亡情况。结果液体复苏后,3组与1、2组患者1周前、后的APACHEⅡ评分、SOFA评分、BNP、BUN、总胆红素水平差值比较,差异有统计学意义(P<0.05);1组与2、3组患者1周前、后的氧合指数差值比较,差异有统计学意义(P<0.05);1、2、3组患者的Cr、LAC水平差值比较,差异无统计学意义(P>0.05)。3组患者的ICU死亡率、心力衰竭发生率高于1、2组(P<0.05);1组的28 d死亡率低于2、3组,机械通气时间短于2、3组(P<0.05);3组患者的利尿剂1周内总量大于2组(P<0.05)。D组患者的ICU死亡率及28 d死亡率均高于A、B、C组,差异具有统计学意义(P<0.05)。根据韦恩图可知,28 d死亡总人数为46例,D组与3组的死亡人数交集为14例,分别占D组死亡人数的60.87%,占3组死亡人数的73.68%,占死亡总数的30.43%。结论休克患者液体复苏成功后,当患者液体入量>3500 mL,且液体平衡量>500 mL时,患者临床预后差,死亡率高。临床医师应加强液体管理,减少液体输注,从而改善患者预后,提高患者存活率。

Study on the relationship between different fluid resuscitation volume and the prognosis and complications of shock patients

Objective To investigate the effects of different fluid resuscitation volume on clinical prognosis and complications of shock patients.Methods A total of 116 shock patients from January 1,2018 to April 30,2019 hospitalized in ICU of Anhui provincial hospital affiliated to Anhui medical university were collected.The patients were divided into three groups according to the volume of liquid intake in one week(group 1:<2500 mL,17 cases;group 2:2500-3500 mL,66 cases;group 3:>3500 mL in 33 cases);the patients were divided into four groups according to the liquid balance volume(group A:<-500 mL,22 cases;group B:-500-<0 mL,27 cases;group C:0-500 mL,36 cases;group D:>500 mL,31 cases).The age,gender,APACHE Ⅱ scores,SOFA scores,oxygenation indexes,levels of BNP,Cr,BUN,LAC,total bilirubin,ICU mortality rates,28 d mortality rates,incidences of heart failure,ICU hospitalization days,mechanical ventilation time,total diuretic volume in one week were compared among different liquid intake groups;the ICU mortality rates,28 d mortality rates among different liquid balance volume groups were compared;the 28 d mortality of patients with two grouping methods were analyzed by Venn diagram.Results After fluid resuscitation,the differences of APACHEⅡscores,SOFA scores,BNP,BUN and total bilirubin levels before and after one week between the group 3 and the group 1,2 had statistically significant differences(P<0.05).The differences of oxygenation indexes before and after one week between the group 1 and the group 2,3 had statistically significant differences(P<0.05).There were no significant differences in the levels differences of Cr and LAC among the group 1,2,3(P>0.05).The ICU mortality rate and incidence of heart failure in the group 3 were higher than those in the group 1,2(P<0.05).The 28 d mortality rate of the group 1 were lower than those of the group 2,3,and the mechanical ventilation duration was shorter than that of the group 2,3(P<0.05);the total diuretic volume in one week in the group 3 was greater than that in the group 2(P<0.05).The ICU mortality rate and 28 d mortality rate in the group D were higher than those in the group A,B and C,the differences were statistically significant(P<0.05).Venn diagram showed that the amount of 28 d mortality was 46 cases,and the intersection of deaths of the group D and the group 3 was 14 cases,accounting for 60.87%and 73.68%of deaths of the group D and the group 3 respectively,accounting for 30.43%of the total number of deaths.Conclusion After successful fluid resuscitation in shock patients,when the volume of liquid intake>3500 mL and the volume of fluid balance>500 mL,the patients has poor clinical prognosis and high mortality.Clinicians should strengthen fluid management and reduce fluid infusion,so as to improve the prognosis and survival rate of patients.