학술논문
重症超声对脓毒性休克合并射血分数保留的心力衰竭患者液体复苏的研究 / Guiding value of severe ultrasound in fluid resuscitation of septic shock patients with heart failure with preserved ejection fraction
Document Type
Academic Journal
Author
Source
中国急救复苏与灾害医学杂志 / China Journal of Emergency Resuscitation and Disaster Medicine. 19(2):177-182
Subject
Language
Chinese
ISSN
1673-6966
Abstract
目的 探讨重症超声在脓毒性休克伴HFPEF患者的液体复苏的指导意义.方法 将中山市人民医院南朗分院在 2020 年 9 月—2021 年 10 月期间收住院治疗的 116 例脓毒性休克患者作为研究对象,全部患者在入院时均存在射血分数保留的心力衰竭,随机分为对照组和研究组,每组各 58 例,两组患者均对患者进行液体复苏,按照进行液体复苏的方式分为对照组(常规方式)及研究组(重症超声指导下).对比两组患者复苏前后血流动力学变化指标,同时对比两组患者在院期间的临床治疗指标.结果 组内比较,平均动脉压、中心静脉压及中心静脉血氧饱和度三项指标在复苏后 6h、24h后两个时间节点均明显高于复苏前,差异有统计学意义(P＜0.05),心率均低于复苏前(P＜0.05);与复苏 24h后两组患者平均动脉压、中心静脉压及中心静脉血氧饱和度三项指标比复苏后 6h水平升高,差异有统计学意义(P＜0.05),心率均降低(P＜0.05);且复苏各时间点研究组平均动脉压、中心静脉压及中心静脉血氧饱和度水平均高于对照组(P＜0.05),心率低于对照组(P＜0.05);两组血乳酸、血清N末端利钠肽前体水平在复苏前、复苏 24 h、复苏 48 h、复苏 72h依次降低(P＜0.05),且研究组复苏各时间点血乳酸、血清N末端利钠肽前体水平均低于对照组(P＜0.05);两组心脏指数、左心室每搏作功指数水平在复苏前、复苏 24 h、复苏 48 h、复苏 72h依次升高(P＜0.05),且研究组复苏各时间点心脏指数、左心室每搏做功指数水平均高于对照组(P＜0.05);研究组复苏阶段晶体液总摄入量[(11 317.83±2 158.53)mL vs.(13 254.28±2 759.14)mL]、去甲肾上腺素使用量[(36.16±6.54)mg vs.(47.58±8.21)mg]均低于对照组(P＜0.05);研究组患者 28d病死率与对照组比较无统计学意义(3.45%vs..5.17%,P＞0.05);研究组肺水肿发生率低于对照组(8.62%vs.22.41%,P＜0.05),ICU停留时间短于对照组[(10.61±2.12)d vs.(12.58±2.49)d,P＜0.05].结论 常规治疗与重症超声指导下进行液体复苏进行比较发现,重症超声指导下对脓毒性休克合并HFPEF患者能对患者的血流动力学恢复产生积极作用,同时能有效改善患者的组织灌注,对患者的心功能恢复产生有利作用,并且能够对疾病的预后有积极作用.
Objective To explore the guiding value of severe ultrasound in fluid resuscitation of septic shock patients with heart failure with preserved ejection fraction(HFPEF).Methods From September 2020 to October 2021,a total of 116 patients with septic shock admitted to Zhongshan City People's Hospital Nanlang Branch were selected as the study subjects.All patients presented with heart failure characterized by preserved ejection fraction upon admission.They were randomly divided into a control group and a study group,with 58 patients in each group.Both groups underwent fluid resuscitation,with the control group following the conventional approach and the study group guided by critical care ultrasound.The aim of the study is to compare hemodynamic changes in both groups before and after fluid resuscitation and simultaneously analyze clinical treatment indicators during the patients'hospitalization.Results Intra-group comparisons showed that the average arterial pressure,central venous pressure,and central venous oxygen saturation were significantly higher at 6 hours and 24 hours after resuscitation compared to before resuscitation,with statistical significance(P<0.05).Heart rates were lower than before resuscitation(P<0.05).Compared with the levels at 6 hours after resuscitation,the average arterial pressure,central venous pressure,and central venous oxygen saturation were higher at 24 hours after resuscitation,with statistical significance(P<0.05),while heart rates were lower(P<0.05).Additionally,at each time point of resuscitation,the study group had higher levels of average arterial pressure,central venous pressure,and central venous oxygen saturation than the control group(P<0.05),with lower heart rates than the control group(P<0.05).Both groups showed decreasing levels of blood lactate and serum N-terminal pro-brain natriuretic peptide(NT-proBNP)levels at 24 hours,48 hours,and 72 hours after resuscitation compared to before resuscitation(P<0.05).Moreover,at each time point of resuscitation,the study group had lower levels of blood lactate and serum NT-proBNP than the control group(P<0.05).Cardiac index and left ventricular stroke index levels increased at 24 hours,48 hours,and 72 hours after resuscitation compared to before resuscitation(P<0.05).Furthermore,at each time point of resuscitation,the study group had higher levels of cardiac index and left ventricular stroke index than the control group(P<0.05).During the resuscitation phase,the crystalloid fluid total intake[(11 317.83±2 158.53)mL vs(13 254.28±2 759.14)mL]and norepinephrine usage[(36.16±6.54)mg vs.(47.58±8.21)mg]were both lower in the study group than in the control group(P<0.05).The 28 days mortality rate in the study group did not differ significantly from that in the control group(3.45%vs.5.17%,P>0.05).The incidence of pulmonary edema in the study group was lower than that in the control group(8.62%vs.22.41%,P<0.05),and the ICU stay time was shorter than that in the control group[(10.61±2.12)days vs.(12.58±2.49)days,P<0.05]Conclusion Compared with conventional treatment and fluid resuscitation under the guidance of severe ultrasound,it is found that the fluid resuscitation under the guidance of severe ultrasound can have a positive effect on the hemodynamic recovery of patients with septic shock and HFPEF,and can effectively improve the tissue perfusion of patients,and it has a beneficial effect on the recovery of cardiac function of patients and has a positive effect on the prognosis of the disease,which is recommended for clinical use.
Objective To explore the guiding value of severe ultrasound in fluid resuscitation of septic shock patients with heart failure with preserved ejection fraction(HFPEF).Methods From September 2020 to October 2021,a total of 116 patients with septic shock admitted to Zhongshan City People's Hospital Nanlang Branch were selected as the study subjects.All patients presented with heart failure characterized by preserved ejection fraction upon admission.They were randomly divided into a control group and a study group,with 58 patients in each group.Both groups underwent fluid resuscitation,with the control group following the conventional approach and the study group guided by critical care ultrasound.The aim of the study is to compare hemodynamic changes in both groups before and after fluid resuscitation and simultaneously analyze clinical treatment indicators during the patients'hospitalization.Results Intra-group comparisons showed that the average arterial pressure,central venous pressure,and central venous oxygen saturation were significantly higher at 6 hours and 24 hours after resuscitation compared to before resuscitation,with statistical significance(P<0.05).Heart rates were lower than before resuscitation(P<0.05).Compared with the levels at 6 hours after resuscitation,the average arterial pressure,central venous pressure,and central venous oxygen saturation were higher at 24 hours after resuscitation,with statistical significance(P<0.05),while heart rates were lower(P<0.05).Additionally,at each time point of resuscitation,the study group had higher levels of average arterial pressure,central venous pressure,and central venous oxygen saturation than the control group(P<0.05),with lower heart rates than the control group(P<0.05).Both groups showed decreasing levels of blood lactate and serum N-terminal pro-brain natriuretic peptide(NT-proBNP)levels at 24 hours,48 hours,and 72 hours after resuscitation compared to before resuscitation(P<0.05).Moreover,at each time point of resuscitation,the study group had lower levels of blood lactate and serum NT-proBNP than the control group(P<0.05).Cardiac index and left ventricular stroke index levels increased at 24 hours,48 hours,and 72 hours after resuscitation compared to before resuscitation(P<0.05).Furthermore,at each time point of resuscitation,the study group had higher levels of cardiac index and left ventricular stroke index than the control group(P<0.05).During the resuscitation phase,the crystalloid fluid total intake[(11 317.83±2 158.53)mL vs(13 254.28±2 759.14)mL]and norepinephrine usage[(36.16±6.54)mg vs.(47.58±8.21)mg]were both lower in the study group than in the control group(P<0.05).The 28 days mortality rate in the study group did not differ significantly from that in the control group(3.45%vs.5.17%,P>0.05).The incidence of pulmonary edema in the study group was lower than that in the control group(8.62%vs.22.41%,P<0.05),and the ICU stay time was shorter than that in the control group[(10.61±2.12)days vs.(12.58±2.49)days,P<0.05]Conclusion Compared with conventional treatment and fluid resuscitation under the guidance of severe ultrasound,it is found that the fluid resuscitation under the guidance of severe ultrasound can have a positive effect on the hemodynamic recovery of patients with septic shock and HFPEF,and can effectively improve the tissue perfusion of patients,and it has a beneficial effect on the recovery of cardiac function of patients and has a positive effect on the prognosis of the disease,which is recommended for clinical use.