CAJ | 학술논문

　　目的探讨慢性阻塞性肺疾病（COPD）合并感染性休克患者依据舒张末期容积指数（GEDI）进行液体复苏的临床效果。方法按照随机数字表法将于我科治疗的44例COPD并感染性休克患者分为观察组与对照组，各22例，对照组依照中心静脉压（CVP）标准进行液体复苏，观察组则在血流动力学监测技术PICCO的监测下依照GEDI进行液体复苏，复苏24 h后，比较两组患者的平均液体复苏量及去甲肾上腺素用量，并记录特异指标乳酸清除率、中心静脉血氧饱和度（SCVO2）、碱剩余（BE）及急性生理与慢性健康评分（APACHEⅡ）的变化。结果平均液体复苏量及去甲肾上腺素用量两组比较差异有统计学意义（P＜0.05）。结论对于COPD患者，因患病期长，可能并发右心功能不全，因此CVP不能准确地反映患者的左心容量状态，而依据GEDI进行液体复苏，则可准确反映升压药物用量，值得临床做普遍性应用及推广。
　　목적탐토만성조새성폐질병（COPD）합병감염성휴극환자의거서장말기용적지수（GEDI）진행액체복소적림상효과。방법안조수궤수자표법장우아과치료적44례COPD병감염성휴극환자분위관찰조여대조조，각22례，대조조의조중심정맥압（CVP）표준진행액체복소，관찰조칙재혈류동역학감측기술PICCO적감측하의조GEDI진행액체복소，복소24 h후，비교량조환자적평균액체복소량급거갑신상선소용량，병기록특이지표유산청제솔、중심정맥혈양포화도（SCVO2）、감잉여（BE）급급성생리여만성건강평분（APACHEⅡ）적변화。결과평균액체복소량급거갑신상선소용량량조비교차이유통계학의의（P＜0.05）。결론대우COPD환자，인환병기장，가능병발우심공능불전，인차CVP불능준학지반영환자적좌심용량상태，이의거GEDI진행액체복소，칙가준학반영승압약물용량，치득림상주보편성응용급추엄。
Objective To explore the clinical effect of fluid resuscitation in patients with chronic obstructive pulmonary disease combined with infective shock according to GEDI. Methods 44 patients with COPD combined with infective shock who were treated in our department,in accordance with the random number table, were divided into observation group and control group, with each in 22.The control group underwent fluid resuscitation according to the central venous pressure(CVP) standard,when the observation group underwent fluid resuscitation under PICCO monitoring technology,in accordance with GEDI.The average amount of fluid resuscitation and noradrenaline dosage were compared between the two groups, and the changes of specific indicators lactate clearance rate,SCVO2,BE and APACHEⅡscore were recorded at the same time after resuscitation of 24 h. Results There was significant difference in the average amount of fluid resuscitation and noradrenaline dosage between the two groups(P<0.05). Conclusion COPD patients with disease course of long period,may be concurrent right cardiac insufficiency, so CVP can not reflect the state of patients`left heart capacity accurately.But the fluid resuscitation according to GEDI can reflect drug dosage of elevated blood pressure,and it is worth of application and promotion in clinic.