摘要
目的探究感染性休克合并急性肺损伤(ALI)患者运用液体负平衡对其早期复苏和预后影响的分析。方法选择2013年4月-2015年12月在医院住院治疗感染性休克合并急性肺损伤(ALI)的患者90例,分为治疗组和对照组各45例,两组患者在治疗上均给予抗炎抑菌、控制血糖以及营养支持等对症治疗同时,治疗组患者进行液体负平衡管理模式,而对照组主要是维持患者液体出入量的平衡或适当达到正平衡进行液体的管理模式,对两组患者中心静脉压(CVP)、平均动脉压(MAP)、心指数(CI)、氧合指数(PaO2/FiO2)以及血管外肺脏水指数(ELWI)、APACHEII的评分等进行比较。结果入院治疗后的第5d、7d治疗组患者MAP较对照组患者明显降低,而PaO2/FiO2和ELWI与对照组患者比较明显升高(P<0.05)而CVP治疗后无明显差异;两组患者治疗前治疗组(25.5±4.6)和对照组(23.8±4.0)APACHEII评分上比较差异无统计学意义,入院治疗6h后,两组患者在APACHEII评分上治疗组(23.3±4.2)和对照组(22.9±4.1)差异无统计学意义;而两组患者在入院治疗后24h、48h,治疗组患者APACHEII评分明显低于对照组患者,尤以48h后治疗组(13.1±3.6)和对照组(17.8±3.2)比较(P<0.05);治疗组患者在机械通气时间、患者入住时间均明显短于对照组(P<0.05),治疗组MODS发生率也明显低于对照组(P<0.05)。结论对于感染性休克合并ALI患者运用液体负平衡不仅有利于患者肺功能的改善,其临床效果也是值得肯定的,值得临床推广。
OBJECTIVE To observe the effect of liquid negative balance on early resuscitation and prognosis of septic shock patients complicated with acute lung injury （ALI）. METHODS A total of 90 septic shock patients complicate with ALT who were hospitalized from Apr 2013 to Dec 2015 were enrolled in the study and divided into the treatment group and the control group, with 45 cases in each group. The two groups of patients were given symptom- atic therapies such as anti-inflammation and bacterial inhibition, control of blood glucose, and nutrition support. The treatment group was treated with liquid negative balance, while the control group was mainly treated with the maintenance of balance of fluid intake and output or appropriate to achieve a positive balance in fluid management. The central venous pressure （CVP）, mean arterial pressure （MAP）, cardiac index （CI）, oxygenation index （PaO2/FiO2）, extravascular lung water index （ELWI）, and APACHEII score were compared between the two groups of patients.RESULTS The MAP of the treatment group was significantly lower than that of the control group after the treatment for 5 and 7 days, however, the PaO2/FiO2 and ELWI of the treatment group were remarkably higher than those of the control group （P〈0.05）, there was no significant difference in the CVP after the treatment. The APACHEII score of the treatment group was （25.5 ± 4.6） before the treatment, the control group （23. 8±4. 0）, there was no significant difference; the APACHEII score of the treatment group was （23.3±4.2） after the treatment for 6 hours, the control group （22.9±4.1）, and there was no significant differ- ence however, the APACHEII score of the treatment group was significantly lower than that of the control group after the treatment for 24 and 48 hours, the APACHEII score of the treatment group was （13.1-4-3.6） after the treatment for 48 hours, the control group （17. 8± 3. 2） （P〈0. 05）. The mechanical ventilation duration and length of hospital stay were significantly shorter in the treatment group than in the control group （P〈0.05）. The incidence of MODS of the treatment group was significantly lower than that of the control group （P〈0. 05）. CONCLUSION The use of liquid negative balance may facilitate the improvement of lung function of the septic shock patients complicated with ALI and achieve satisfied clinical effect, and it is worthy to be promoted in the hospital.
作者
胡妙仙
林根友
林相彬
陶福正
莫恩君
HU Miao-xian LIN Gen-you LIN Xiang-bin TAO Fu-zheng MO En-jun(Taizhou Integrated Traditional Chinese and Western Medicine Hospital, Taizhou, Zhejiang 317523, China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2017年第5期1000-1003,共4页
Chinese Journal of Nosocomiology
基金
浙江省科技厅科研基金资助项目(2013C31129)
关键词
液体
负平衡
感染性休克
急性肺损伤
早期复苏
预后
Liquid
Negative balance
Septic shock
Acute lung injury
Early resuscitation
Prognosis
