不同液体复苏策略对脓毒性休克患者呼吸力学及氧合的影响

发布时间：2018-04-05 05:11

本文选题：休克　切入点：脓毒性　出处：《重庆医学》2017年36期

【摘要】：目的观察不同液体复苏策略对脓毒性休克患者呼吸力学及氧合的影响。方法回顾性调查分析该院重症医学科(ICU)125例脓毒性休克患者72h的救治资料,根据液体复苏结果分成限制性液体复苏组(n=58)和开放性液体复苏组(n=67),比较两组复苏前后的呼吸力学(静态肺顺应性、吸气阻力)及氧合的变化,同时记录两组血流动力学及血管活性药物应用情况。结果两组患者血流动力学指标差异无统计学意义(P0.05),开放性液体复苏组的血管活性药物用量及时长均较限制性液体复苏组少或短(P0.01);两组的气道阻力复苏前、后无明显变化,复苏后限制性液体复苏组的肺顺应性及氧合均优于开放性液体复苏组(P0.01)。随着液体复苏量的增加,无论是限制性液体复苏组还是开放性液体复苏组,肺的顺应性均进行性变差,尤其是在开放性液体复苏组患者更为明显(P0.01);液体复苏的量与肺顺应性及氧合呈负相关(R=-0.783、-0.860,P0.01)。结论脓毒性休克救治时,开放性复苏策略虽然血管活性药物用量少、时长短,但是肺的顺应性及氧合均受影响,而限制液体复苏策略则相反。
[Abstract]:Objective to observe the effects of different fluid resuscitation strategies on respiratory mechanics and oxygenation in septic shock patients.Methods the clinical data of 125 patients with septic shock were analyzed retrospectively.According to the results of fluid resuscitation, they were divided into restricted fluid resuscitation group and open fluid resuscitation group. The changes of respiratory mechanics (static lung compliance, inspiratory resistance) and oxygenation before and after resuscitation were compared between the two groups.Hemodynamics and vasoactive drugs were recorded in both groups.Results there was no significant difference in hemodynamic indexes between the two groups (P 0.05). The dosage of vasoactive drugs in the open fluid resuscitation group was shorter or shorter than that in the restrictive fluid resuscitation group, but there was no significant change in the airway resistance before and after the resuscitation.The lung compliance and oxygenation of the resuscitation group were better than that of the open fluid resuscitation group (P 0.01).With the increase of fluid resuscitation, the lung compliance of both the restricted fluid resuscitation group and the open fluid resuscitation group decreased progressively.Especially in the open fluid resuscitation group, the volume of fluid resuscitation was negatively correlated with lung compliance and oxygenation.Conclusion in the treatment of septic shock, although the dosage of vasoactive drugs is small and the duration is long, the lung compliance and oxygenation are affected, while the resuscitation strategy is opposite.
【作者单位】：广西中医药大学第一附属医院ICU;
【基金】：广西卫生厅计划立项课题(Z2013193)
【分类号】：R459.7

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