中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2012年
11期
967-970
,共4页
陈进%严静%龚仕金%蔡国龙%戴海文%虞意华%许强宏%颜默磊%谭成戊%吴亮
陳進%嚴靜%龔仕金%蔡國龍%戴海文%虞意華%許彊宏%顏默磊%譚成戊%吳亮
진진%엄정%공사금%채국룡%대해문%우의화%허강굉%안묵뢰%담성무%오량
脓毒症%复苏术%每搏输出量
膿毒癥%複囌術%每搏輸齣量
농독증%복소술%매박수출량
Sepsis%Resuscitation%Stroke volume
目的 在老年脓毒症患者进行液体复苏过程中,观察每搏输出量变异指数(SVV)为复苏指标时相应的功能性血流动力学参数的变化、组织灌注的改善及预后. 方法 选取30例老年脓毒症患者进行早期目标指导治疗(EGDT),在液体复苏同时予脉搏指数连续心输出量监测(PiCCO)监测,随机将患者分为研究组和标准液体复苏组(对照组).观察复苏前和6h后达标患者的中心静脉压(CVP)、全心舒张末容积指数(GEDVI)、胸腔内血容量指数(ITBVI)、血管外肺水指数(EVLWI)、心排指数(CI)、中心静脉血氧饱和度(ScvO2)和乳酸清除率、急性生理和慢性健康评分(APACHEⅡ)评分.其后观察第3天APACHEⅡ变化、需要进行连续性肾脏替代治疗(CRRT)的例数、机械通气时间、ICU住院时间及28 d病死率. 结果 两组28 d病死率差异无统计学意义(x2=0.240,P=0.624).但是在存活患者中,与对照相比较,研究组患者ICU住院时间、机械通气时间缩短(t=2.166,P=0.041;t=2.104,P=0.046),第3天APACHE Ⅱ评分降低(t=2.20,P=0.038),需要进行CRRT的例数无统计学差异.在存活患者中,研究组的CVP、ITBVI、GEDVI、CI、乳酸清除率均明显高于对照组(t=2.759,P=0.011;t=2.146,P=0.043;t=2.199,P=0.038；t=2.654,P=0.014；t=3.362,P=0.003),EVLWI和Apache Ⅱ评分差异无统计学意义. 结论 在机械通气状态下老年脓毒症患者液体复苏治疗中,以SVV作为复苏目标的液体复苏方案,较以CVP为指导的EGDT方案达到更好的复苏效果,并在一定程度上改善预后.
目的 在老年膿毒癥患者進行液體複囌過程中,觀察每搏輸齣量變異指數(SVV)為複囌指標時相應的功能性血流動力學參數的變化、組織灌註的改善及預後. 方法 選取30例老年膿毒癥患者進行早期目標指導治療(EGDT),在液體複囌同時予脈搏指數連續心輸齣量鑑測(PiCCO)鑑測,隨機將患者分為研究組和標準液體複囌組(對照組).觀察複囌前和6h後達標患者的中心靜脈壓(CVP)、全心舒張末容積指數(GEDVI)、胸腔內血容量指數(ITBVI)、血管外肺水指數(EVLWI)、心排指數(CI)、中心靜脈血氧飽和度(ScvO2)和乳痠清除率、急性生理和慢性健康評分(APACHEⅡ)評分.其後觀察第3天APACHEⅡ變化、需要進行連續性腎髒替代治療(CRRT)的例數、機械通氣時間、ICU住院時間及28 d病死率. 結果 兩組28 d病死率差異無統計學意義(x2=0.240,P=0.624).但是在存活患者中,與對照相比較,研究組患者ICU住院時間、機械通氣時間縮短(t=2.166,P=0.041;t=2.104,P=0.046),第3天APACHE Ⅱ評分降低(t=2.20,P=0.038),需要進行CRRT的例數無統計學差異.在存活患者中,研究組的CVP、ITBVI、GEDVI、CI、乳痠清除率均明顯高于對照組(t=2.759,P=0.011;t=2.146,P=0.043;t=2.199,P=0.038；t=2.654,P=0.014；t=3.362,P=0.003),EVLWI和Apache Ⅱ評分差異無統計學意義. 結論 在機械通氣狀態下老年膿毒癥患者液體複囌治療中,以SVV作為複囌目標的液體複囌方案,較以CVP為指導的EGDT方案達到更好的複囌效果,併在一定程度上改善預後.
목적 재노년농독증환자진행액체복소과정중,관찰매박수출량변이지수(SVV)위복소지표시상응적공능성혈류동역학삼수적변화、조직관주적개선급예후. 방법 선취30례노년농독증환자진행조기목표지도치료(EGDT),재액체복소동시여맥박지수련속심수출량감측(PiCCO)감측,수궤장환자분위연구조화표준액체복소조(대조조).관찰복소전화6h후체표환자적중심정맥압(CVP)、전심서장말용적지수(GEDVI)、흉강내혈용량지수(ITBVI)、혈관외폐수지수(EVLWI)、심배지수(CI)、중심정맥혈양포화도(ScvO2)화유산청제솔、급성생리화만성건강평분(APACHEⅡ)평분.기후관찰제3천APACHEⅡ변화、수요진행련속성신장체대치료(CRRT)적례수、궤계통기시간、ICU주원시간급28 d병사솔. 결과 량조28 d병사솔차이무통계학의의(x2=0.240,P=0.624).단시재존활환자중,여대조상비교,연구조환자ICU주원시간、궤계통기시간축단(t=2.166,P=0.041;t=2.104,P=0.046),제3천APACHE Ⅱ평분강저(t=2.20,P=0.038),수요진행CRRT적례수무통계학차이.재존활환자중,연구조적CVP、ITBVI、GEDVI、CI、유산청제솔균명현고우대조조(t=2.759,P=0.011;t=2.146,P=0.043;t=2.199,P=0.038；t=2.654,P=0.014；t=3.362,P=0.003),EVLWI화Apache Ⅱ평분차이무통계학의의. 결론 재궤계통기상태하노년농독증환자액체복소치료중,이SVV작위복소목표적액체복소방안,교이CVP위지도적EGDT방안체도경호적복소효과,병재일정정도상개선예후.
Objective To investigate the clinical values of central venous pressure (CVP) versus stroke volume variation (SVV) in patients with severe sepsis after early goal-directed therapy (EGDT).Methods Totally 30 mechanically ventilated patients with severe sepsis who underwent goal-achieved EGDT were enrolled and randomly divided into CVP group (study group) and SVV group (control group) according to the data detected by pulse contour continuous cardiac output (PiCCO) analysis device.The differences in 28-day survival,3-day APACHE Ⅱ score,time of ICU stay,duration of mechanical ventilation,number that need CRRT,entral venous pressure (CVP),heart end-diastolic volume index (GEDVI),intrathoracic blood volume index (ITBVI),extravascular lung water index (EVLWI),cardiac index (CI),central venous oxygen saturation (ScvO2),lactate clearance rate and APACHE Ⅱ score were compared between the 2 groups.Results The death rate had no difference between the 2 groups(x2=0.240,P=0.624).Among survival patients in the CVP group,the time of ICU stay and duration of mechanical ventilation were shorter in study group than in control group(t=2.166,P=0.041;t=2.104,P=0.046),APACHE Ⅱ score at 3th day was decreased(t=2.20,P =0.038).The values of ITBVI,GEDVI,CI,lactate clearance rate were higher in study group than in control group (t=2.759,2.146,2.199,2.654,3.362,P=0.011,0.043,0.038,0.014,0.003).EVLWI and APACHE Ⅱ score were not different (P＞0.05) between the two groups.Conclusions SVV as a recovery target for fluid resuscitation can reach a better recovery results and improvement of prognosis than CVP goal-achieved EGDT.
