CAJ | 학술논문

目的探讨以中心静脉压(CVP)或每搏输出量变异(SVV)为目标的早期液体复苏方案对老年脓毒症患者血管外肺水(EVLW)及预后的影响.方法将59例老年脓毒症患者随机分为CVP组和SVV组,根据不同的复苏目标(分别是CVP、SVV达标)进行早期液体复苏,评价两组患者的预后,比较不同的液体复苏方案对血管外肺水指数(EVLWI)的影响,并分析复苏后EVLWI过高的影响因素.结果复苏后,与CVP组相比,SVV组机械通气时间及ICU住院时间缩短(均P<0.05),但两组28d病死率(SVV组35.7%,CVP组48.3%)差异无统计学意义(P>0.05).两组复苏前EVLWI差异无统计学意义(P>0.05),复苏后均有增加(均P<0.05),且复苏后SVV组EVLWI≥9ml/kg的例数较少(SVV组11例,CVP组18例).回归分析显示复苏后EVLWI≥9ml/kg的主要影响因素包括:基础EVLWI较高、达标时SVV较低、复苏导致的CI增加较少和SVV增加较多.结论早期液体复苏可导致老年脓毒症患者的EVLWI明显升高.依据SVV对老年脓毒症患者进行液体复苏比CVP作为复苏目标,达标时EVLWI过高的危险性减小.
목적탐토이중심정맥압(CVP)혹매박수출량변이(SVV)위목표적조기액체복소방안대노년농독증환자혈관외폐수(EVLW)급예후적영향.방법장59례노년농독증환자수궤분위CVP조화SVV조,근거불동적복소목표(분별시CVP、SVV체표)진행조기액체복소,평개량조환자적예후,비교불동적액체복소방안대혈관외폐수지수(EVLWI)적영향,병분석복소후EVLWI과고적영향인소.결과복소후,여CVP조상비,SVV조궤계통기시간급ICU주원시간축단(균P<0.05),단량조28d병사솔(SVV조35.7%,CVP조48.3%)차이무통계학의의(P>0.05).량조복소전EVLWI차이무통계학의의(P>0.05),복소후균유증가(균P<0.05),차복소후SVV조EVLWI≥9ml/kg적례수교소(SVV조11례,CVP조18례).회귀분석현시복소후EVLWI≥9ml/kg적주요영향인소포괄:기출EVLWI교고、체표시SVV교저、복소도치적CI증가교소화SVV증가교다.결론조기액체복소가도치노년농독증환자적EVLWI명현승고.의거SVV대노년농독증환자진행액체복소비CVP작위복소목표,체표시EVLWI과고적위험성감소.
Objective To evaluate the effect of fluid therapy on EVLWI in elderly patients with sepsis based on different targets (CVP or SVV ). Methods Fifty nine elderly patients with sepsis were randomly divided into CVP group and SVV group. Fluid treatment with different targets was given to the two groups. The 6-h total infusion volume, EVLWI and other dynamic pa-rameters, the length of ICU stay, duration of mechanical ventilation and 28-d mortality were recorded and compared between two groups. The reason of EVLWI higher than 9 ml/kg was analyzed by using two logistic regression models. Results There were no differences in al basic factors between two groups. The EVLWI was higher after EGDT than that before EGDT in both groups. There was no significant difference in 28-d survival between two groups. Compared to the CVP group, the 6-h total flu-id volume was reduced and length of ICU stay was shortened, and the level of EVLWI and the number of EVLWI≥9 ml/kg was lower. The corresponding factors of EVLWI≥9 ml/kg included the level of basic EVLWI, the SVV after fluid treatment,△SVV and△CI. Conclusion EVLWI always increases during fluid therapy in the elderly patients with sepsis. Using SVV to guide EGDT may decrease the possibility of EVLWI≥9 ml/kg in fluid therapy.