感染性休克合并急性肺损伤患者运用液体负平衡对其早期复苏和预后的影响

发布时间：2018-02-21 07:04

本文关键词： 液体负平衡感染性休克急性肺损伤早期复苏预后　出处：《中华医院感染学杂志》2017年05期 　论文类型：期刊论文

【摘要】：目的探究感染性休克合并急性肺损伤(ALI)患者运用液体负平衡对其早期复苏和预后影响的分析。方法选择2013年4月-2015年12月在医院住院治疗感染性休克合并急性肺损伤(ALI)的患者90例,分为治疗组和对照组各45例,两组患者在治疗上均给予抗炎抑菌、控制血糖以及营养支持等对症治疗同时,治疗组患者进行液体负平衡管理模式,而对照组主要是维持患者液体出入量的平衡或适当达到正平衡进行液体的管理模式,对两组患者中心静脉压(CVP)、平均动脉压(MAP)、心指数(CI)、氧合指数(PaO2/FiO2)以及血管外肺脏水指数(ELWI)、APACHEII的评分等进行比较。结果入院治疗后的第5d、7d治疗组患者MAP较对照组患者明显降低,而PaO2/FiO2和ELWI与对照组患者比较明显升高(P0.05)而CVP治疗后无明显差异;两组患者治疗前治疗组(25.5±4.6)和对照组(23.8±4.0)APACHEII评分上比较差异无统计学意义,入院治疗6h后,两组患者在APACHEII评分上治疗组(23.3±4.2)和对照组(22.9±4.1)差异无统计学意义;而两组患者在入院治疗后24h、48h,治疗组患者APACHEII评分明显低于对照组患者,尤以48h后治疗组(13.1±3.6)和对照组(17.8±3.2)比较(P0.05);治疗组患者在机械通气时间、患者入住时间均明显短于对照组(P0.05),治疗组MODS发生率也明显低于对照组(P0.05)。结论对于感染性休克合并ALI患者运用液体负平衡不仅有利于患者肺功能的改善,其临床效果也是值得肯定的,值得临床推广。
[Abstract]:Objective to explore the effect of negative fluid balance on early resuscitation and prognosis in patients with septic shock complicated with acute lung injury. Methods from April 2013 to December 2015, patients with septic shock and acute lung injury were hospitalized for treatment of septic shock complicated with acute lung. There were 90 patients with ALI, They were divided into treatment group and control group with 45 cases each. Both groups were treated with anti-inflammatory and bacteriostasis, control of blood glucose and nutritional support and other symptomatic treatments. Meanwhile, the patients in the treatment group were treated with negative liquid balance management mode. The control group is mainly to maintain the balance of the patient's fluid flow out or to properly achieve the positive balance to carry out the liquid management mode. The central venous pressure (CVP), mean arterial pressure (MAPP), cardiac index (CI), oxygenation index (Pao _ 2 / FiO _ 2) and extravascular pulmonary water index (ELW) were compared between the two groups. Results the MAP in the treatment group was significantly lower than that in the control group on the 5th day after admission. The scores of PaO2/FiO2 and ELWI were significantly higher than those of the control group (P 0.05), but there was no significant difference between the two groups after CVP treatment, and there was no significant difference between the treatment group and the control group before treatment (25.5 卤4.6) and the control group (23.8 卤4.0), 6 hours after admission to hospital, there was no significant difference between the two groups. There was no significant difference in APACHEII score between the treatment group (23.3 卤4.2) and the control group (22.9 卤4.1), but the APACHEII score of the treatment group was significantly lower than that of the control group at 24 hours after admission. After 48 hours, there were significant differences between the treatment group (13.1 卤3.6) and the control group (17.8 卤3.2). The MODS incidence in the treatment group was significantly lower than that in the control group (P 0.05). Conclusion the negative liquid balance in patients with septic shock and ALI is not only beneficial to the improvement of pulmonary function. Its clinical effect is also worthy of affirmation, worthy of clinical promotion.
【作者单位】：台州市中西医结合医院急诊科;台州市中西医结合医院消化内科;台州市中西医结合医院重症医学科;
【基金】：浙江省科技厅科研基金资助项目(2013C31129)
【分类号】：R459.7;R563

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