摘要
目的 探究感染性休克液体复苏完成时限对患者病情转归的影响.方法 选取2020 年7 月—2023 年7 月收治的感染性休克156 例,根据液体复苏完成时限分为<1h组68 例、1～2h组57 例、≥2h组31 例.比较3 组液体复苏前后急性生理和慢性健康状况评分(APACHEⅡ)、序贯器官衰竭评分(SOFA)、血流动力学指标[中心静脉压(CVP)、心指数、外周血管阻力指数(SVRI)、每搏量指数(SVI)]、血乳酸、pH值、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、血管外肺水指数(ELWI)、肺血管通透性指数(PVPI)、血肌酐、液体复苏量,以及去甲肾上腺素应用剂量、重症监护病房(ICU)住院时间、机械通气时间、28d生存率.结果 <1h组、1～2h组复苏后APACHEⅡ、SOFA评分低于≥2h组(P<0.05);≤1h组、1～2h组复苏后APACHEⅡ、SOFA评分无明显差异(P>0.05);<1h组、1～2h组复苏后CVP、心指数、SVI高于≥2h组,SVRI低于≥2h组(P<0.05);<1h组、1～2h组复苏后CVP、心指数、SVRI、SVI比较无明显差异(P>0.05).<1h组、1～2h组复苏后血乳酸低于≥2h组(P<0.05);<1h组、1～2h组复苏后血乳酸比较无明显差异(P>0.05);3 组复苏后血 pH 值、PaO2、PaCO2 比较无明显差异(P>0.05).<1h组复苏后ELWI、PVPI、血肌酐高于复苏前,并高于1～2h组、≥2h组(P<0.05);3 组1h液体复苏量比较无明显差异(P>0.05),<1h组、1～2h组、≥2h组3h液体复苏量呈依次降低趋势(P<0.05).≥2h组去甲肾上腺素剂量高于<1h组、1～2h组(P<0.05);<1h组ICU住院时间、机械通气时间长于 1～2h组、≥2h组(P<0.05).1～2h组、≥2h组28d生存率高于<1h组(P<0.05,P<0.01).结论 感染性休克患者初始液体复苏应在1～2h内完成,能有效改善器官功能障碍和病情,维持血流动力学水平,加快恢复进程,促进病情良好转归.
Abstract
Objective To explore the effect of completion time of fluid resuscitation of septic shock on the outcome of patients'disease.Methods A total of 156 patients with septic shock admitted from July 2020 to July 2023 were divided into<1 h group(n =68),1-2 h(n =57)and≥2 h group(n =31)according to the completion time of fluid resuscitation.Acute physiological and chronic health status score(APACHEⅡ),sequential organ failure score(SOFA),hemodynamic in-dicators[Central Venous pressure(CVP),cardiac index,systemic vascular resistance index(SVRI),stroke volume index(SVI)],blood lactic acid,pH value,arterial partial oxygen pressure(PaO2),partial pressure of carbon dioxide(PaCO2),extravascular lung water index(ELWI),pulmonary vascular permeability index(PVPI),serum creatinine,fluid resuscitation volume,and dose of norepinephrine applied,length of stay in intensive care unit(ICU),mechanical ventilation time,and 28-day survival rate of the three groups were compared before and after fluid resuscitation.Results The scores of APACHEⅡand SOFA in<1 h group and1-2 h group were lower than those in≥2 h group(P<0.05).There were no significant differ-ences in APACHEⅡ and SOFA scores between<1 h group and 1-2 h group after resuscitation(P>0.05).After resuscita-tion,CVP,cardiac index and SVI in<1 h group and1-2 h group were higher than those in≥2 h group,and SVRI was lower than those in≥2 h group(P<0.05).There were no significant differences in CVP,cardiac index,SVRI and SVI between<1 h group and1-2 h group after resuscitation(P>0.05).The blood lactic acid of<1 h group and 1-2 h group after resus-citation was lower than that of≥2 h group(P<0.05).There was no significant difference in blood lactic acid between<1 h group and 1-2 h group after resuscitation(P>0.05).There were no significant differences in pH,PaO2 and PaCO2 among the three groups after resuscitation(P>0.05).ELWI,PVPI and serum creatinine in<1 h group were higher than those be-fore resuscitation,and higher than those in 1-2 h group and≥2 h group(P<0.05).There was no significant difference in 1 h liquid resuscitation volume among the three groups(P>0.05),and the 3 h liquid resuscitation volume of<1 h group,1-2 h group and≥2 h group showed a decreasing trend successively(P<0.05).The dose of norepinephrine in≥2 h group was higher than that in<1 h group and 1-2 h group(P<0.05)and the length of ICU stay and mechanical ventilation time in<1 h group were longer than those in 1-2 h group and≥2 h group(P<0.05).The 28-day survival rate of 1-2 h group and≥2 h group was higher than that of<1 h group(P<0.05,P<0.01).Conclusion The initial fluid resuscitation of septic shock patients should be completed within 1-2 h,which can effectively improve the organ dysfunction and severity of disease,maintain the hemodynamic level,accelerate the recovery process and promote the favorable outcome of the disease.
基金项目
四川省卫生健康委适宜技术推广项目(2019)(19SYJS05)
维普
万方数据