目的 探讨胸腔内血容量指数(ITBVI)在感染性休克患者液体管理中的应用价值.方法 采用前瞻性临床观察研究方法,将入住重症监护病房(ICU)的33例感染性休克患者分为两组.ITBVI组17例患者接受脉搏指示连续心排血量(PiCCO)监测,以ITBVI作为液体管理的指导指标;对照组16例患者以中心静脉压(CVP)作为液体管理的指导指标.对比两组患者治疗1 d和3 d时的急性生理学与慢性健康状况评分系统I(APACHE I)评分、感染相关器官功能衰竭评分系统(SOFA)评分、血管活性药物评分,以及补液72 h内两组患者的液体管理数据.结果 ①ITBVI组3 d时APACHE I、SOFA和血管活性药物评分(分)均较1 d时显著下降[21.3±6.2比25.4±7.2,6.1±3.4比9.0±3.5,5.0(0,8.0)比20.0(8.0,35.0),均P＜0.01];而对照组则均无显著变化.②虽然ITBVI组48～72 h液体出量(ml)大于对照组(2 421±868比1 721±934,P=0.039),但ITBVI组与对照组0～72 h的液体出入量和平衡量(ml)比较差异均无统计学意义(入量:9 918±137比10 529±1 331,出量:6 035±1 739比5 827±2 897,平衡量:3 882±1 889比4 703±2 813,均P＞0.05).③在快速补液试验中,ITBVI组与对照组患者除0～6 h胶体液入量[ml:250(125,500)比250(69,250)]差异无统计学意义(P＞0.05)外,其余时段液体入量(ml)ITBVI组均比对照组高[0～6 h晶体液:250(150,250)比125(105,125),6～72 h晶体液:125(125,250)比100(56,125),0～72 h晶体液:250(125,250)比125(75,125),6～72 h胶体液:125(106,250)比75(50,125),0～72 h胶体液:200(125,250)比100(50,125),均P＜0.01].结论 与以CVP指导相比,用ITBVI指导感染性休克患者的液体管理显示,3 d时患者病情较1 d改善,这种改善可能得益于对血容量状态的准确判断和适当的快速补液速度.
目的 探討胸腔內血容量指數(ITBVI)在感染性休剋患者液體管理中的應用價值.方法 採用前瞻性臨床觀察研究方法,將入住重癥鑑護病房(ICU)的33例感染性休剋患者分為兩組.ITBVI組17例患者接受脈搏指示連續心排血量(PiCCO)鑑測,以ITBVI作為液體管理的指導指標;對照組16例患者以中心靜脈壓(CVP)作為液體管理的指導指標.對比兩組患者治療1 d和3 d時的急性生理學與慢性健康狀況評分繫統I(APACHE I)評分、感染相關器官功能衰竭評分繫統(SOFA)評分、血管活性藥物評分,以及補液72 h內兩組患者的液體管理數據.結果 ①ITBVI組3 d時APACHE I、SOFA和血管活性藥物評分(分)均較1 d時顯著下降[21.3±6.2比25.4±7.2,6.1±3.4比9.0±3.5,5.0(0,8.0)比20.0(8.0,35.0),均P＜0.01];而對照組則均無顯著變化.②雖然ITBVI組48～72 h液體齣量(ml)大于對照組(2 421±868比1 721±934,P=0.039),但ITBVI組與對照組0～72 h的液體齣入量和平衡量(ml)比較差異均無統計學意義(入量:9 918±137比10 529±1 331,齣量:6 035±1 739比5 827±2 897,平衡量:3 882±1 889比4 703±2 813,均P＞0.05).③在快速補液試驗中,ITBVI組與對照組患者除0～6 h膠體液入量[ml:250(125,500)比250(69,250)]差異無統計學意義(P＞0.05)外,其餘時段液體入量(ml)ITBVI組均比對照組高[0～6 h晶體液:250(150,250)比125(105,125),6～72 h晶體液:125(125,250)比100(56,125),0～72 h晶體液:250(125,250)比125(75,125),6～72 h膠體液:125(106,250)比75(50,125),0～72 h膠體液:200(125,250)比100(50,125),均P＜0.01].結論 與以CVP指導相比,用ITBVI指導感染性休剋患者的液體管理顯示,3 d時患者病情較1 d改善,這種改善可能得益于對血容量狀態的準確判斷和適噹的快速補液速度.
목적 탐토흉강내혈용량지수(ITBVI)재감염성휴극환자액체관리중적응용개치.방법 채용전첨성림상관찰연구방법,장입주중증감호병방(ICU)적33례감염성휴극환자분위량조.ITBVI조17례환자접수맥박지시련속심배혈량(PiCCO)감측,이ITBVI작위액체관리적지도지표;대조조16례환자이중심정맥압(CVP)작위액체관리적지도지표.대비량조환자치료1 d화3 d시적급성생이학여만성건강상황평분계통I(APACHE I)평분、감염상관기관공능쇠갈평분계통(SOFA)평분、혈관활성약물평분,이급보액72 h내량조환자적액체관리수거.결과 ①ITBVI조3 d시APACHE I、SOFA화혈관활성약물평분(분)균교1 d시현저하강[21.3±6.2비25.4±7.2,6.1±3.4비9.0±3.5,5.0(0,8.0)비20.0(8.0,35.0),균P＜0.01];이대조조칙균무현저변화.②수연ITBVI조48～72 h액체출량(ml)대우대조조(2 421±868비1 721±934,P=0.039),단ITBVI조여대조조0～72 h적액체출입량화평형량(ml)비교차이균무통계학의의(입량:9 918±137비10 529±1 331,출량:6 035±1 739비5 827±2 897,평형량:3 882±1 889비4 703±2 813,균P＞0.05).③재쾌속보액시험중,ITBVI조여대조조환자제0～6 h효체액입량[ml:250(125,500)비250(69,250)]차이무통계학의의(P＞0.05)외,기여시단액체입량(ml)ITBVI조균비대조조고[0～6 h정체액:250(150,250)비125(105,125),6～72 h정체액:125(125,250)비100(56,125),0～72 h정체액:250(125,250)비125(75,125),6～72 h효체액:125(106,250)비75(50,125),0～72 h효체액:200(125,250)비100(50,125),균P＜0.01].결론 여이CVP지도상비,용ITBVI지도감염성휴극환자적액체관리현시,3 d시환자병정교1 d개선,저충개선가능득익우대혈용량상태적준학판단화괄당적쾌속보액속도.
Objective To investigate the value of intrathoracic blood volume index (ITBVI)monitoring in fluid management strategy in septic shock patients. Methods In a prospective study,33 patients who were diagnosed to be suffering from septic shock in the intensive care unit (ICU) were enrolled. Seventeen patients who received pulse-indicator continuous cardiac output (PiCCO) monitoring,and ITBVI was used as indicator of fluid management, were enrolled into ITBVI group; 16 patients who received traditional fluid management strategy[directed by central venous pressure (CVP)]were enrolled into control group. Acute physiology and chronic health evaluation I (APACHE I ) score, sepsis related organ failure assessment (SOFA) score and vasopressor score were compared between 1 day and 3 days of treatment. The characteristics of fluid management were recorded and compared within 72 hours. Results ① In 3 days of treatment, APACHE I , SOFA and vasopressor score were significantly lower in ITBVI group compared with that of in 1 day of treatment[21.3±6. 2 vs. 25. 4±7.2, 6. L±3. 4 vs. 9.0±3.5, 5 (0,8. 0) vs. 20.0 (8. 0, 35.0), respectively, all P＜0. 01], whereas there were no changes in control group.② Although fluid output (ml) was higher in ITBVI group during 48 - 72 hours period (2 421±868 vs.1 721±934, P=0. 039), there was no difference in fluid intake, fluid output or fluid balance (ml) within 0-72 hours between two groups (fluid intake: 9 918±137 vs. 10 529±1 331, fluid output: 6 035±1 739vs. 5 827±2 897, fluid balance: 3 882±1 889 vs. 4 703±2 813, all P＞0. 05). ③Comparing the fluid volume (ml) used for fluid replacement period, except that there was no significance in fluid challenge with colloid during 0- 6 hours between two groups[ml: 250 (125, 500) vs. 250 (69,250), P＞0. 05], more fluid intake (ml) was found in ITBVI group[0 - 6 hours crystalloid: 250 (150,250) vs. 125 (105,125),6- 72 hours crystalloid: 125 (125, 250) vs. 100 (56, 125), 0-72 hours crystalloid: 250 (125, 250) vs. 125(75, 125), 6- 72 hours colloid: 125 (106, 250) vs. 75 (50, 125), 0- 72 hours colloid: 200 (125, 250) vs.100 (50, 125), all P＜0. 01]. Conclusion Clinical picture in patients with septic shock is improved after 3 days of treatment than 1 day of treatment under fluid management directed by ITBVI, compared with by CVP. This improvement may be attributable to accurate assessment of preload and appropriate infusion rate in fluid challenge.
