CAJ | 학술논문

目的：比较限制性和开放性液体复苏策略对脓毒性休克患者预后的影响。方法将46例脓毒性休克患者随机分为开放组和限制组各23例，开放组实施开放性液体复苏策略，限制组实施限制性液体复苏策略。比较2组血流动力学指标、APACHEⅡ和SOFA评分、心功能及心肌损伤改善情况，CRP水平的变化，以及60 d病死率、机械通气时间、入住ICU时间和无脏器衰竭时间的差异。结果复苏后2组HR、MAP、CVP及血乳酸水平改善幅度差异无统计学意义；限制组APACHEⅡ评分、SOFA评分、心功能指标、心肌损伤指标和CRP水平的改善幅度均显著大于开放组（P＜0．05或P＜0．01）。开放组60 d病死率有高于限制组的趋势，但差异无统计学意义（P＞0．05），限制组住ICU时间和机械通气时间均显著短于开放组（P＜0．05或P＜0．01）。结论早期限制性液体复苏策略可有效改善并维持脓毒性休克患者血流动力学的稳定，与开放性液体复苏策略相比，其在降低病死率、缩短ICU入住时间、改善心功能以及减少心肌损伤方面均有一定优势。
목적：비교한제성화개방성액체복소책략대농독성휴극환자예후적영향。방법장46례농독성휴극환자수궤분위개방조화한제조각23례，개방조실시개방성액체복소책략，한제조실시한제성액체복소책략。비교2조혈류동역학지표、APACHEⅡ화SOFA평분、심공능급심기손상개선정황，CRP수평적변화，이급60 d병사솔、궤계통기시간、입주ICU시간화무장기쇠갈시간적차이。결과복소후2조HR、MAP、CVP급혈유산수평개선폭도차이무통계학의의；한제조APACHEⅡ평분、SOFA평분、심공능지표、심기손상지표화CRP수평적개선폭도균현저대우개방조（P＜0．05혹P＜0．01）。개방조60 d병사솔유고우한제조적추세，단차이무통계학의의（P＞0．05），한제조주ICU시간화궤계통기시간균현저단우개방조（P＜0．05혹P＜0．01）。결론조기한제성액체복소책략가유효개선병유지농독성휴극환자혈류동역학적은정，여개방성액체복소책략상비，기재강저병사솔、축단ICU입주시간、개선심공능이급감소심기손상방면균유일정우세。
Objective It is to compare the effects of limited fluid resuscitation and open fluid resuscitation on the prognosis of patients with septic shock .Methods 46 cases of patients with septic shock were randomly divided into open group ( n=23 ) which was given open fluid resuscitation and limited group ( n=23 ) which was given limited fluid resuscitation .The changes of hemodynamics indexes , APACHE Ⅱ, SOFA scores, CRP level, the improvements of cardiac function , cardiac muscle damage, and 60 d mortality, the duration of ventilatory support and ICU stay , and duration with no organ failure were com-pared in both groups .Results After resuscitation, there was no significant difference in the improvements of HR , MAP, CVP and blood lactic acid;The improvements of APACHE II scores , SOFA scores , cardiac function indexes , cardiac muscle dam-age indexes and CRP were more significantly in limited group than those in open group (P<0.05or P<0.01).60 d mortality in open group was higher than that in limited group , but the difference was not significant (P>0.05).The duration of ICU stay and ventilatory support were significantly shorter in limited group than that in open group (P<0.05 or P<0.01).Con-clusion Early limited fluid resuscitation could effectively improve and maintain the stability of hemodynamics in the patients with septic shock , and it had some advantages in decreasing mortality , shortening duration of ICU stay , improving cardiac function and relieving cardiac muscle damage compared with open fluid resuscitation .