外周灌注指数对脓毒性休克患者行液体复苏指导作用

Peripheral perfusion indices to guide fluid resuscitation in patients with septic shock

摘要:

目的 分析外周灌注指数对脓毒性休克患者行液体复苏指导作用。方法 将2020年5月至2021年8月在金昌市人民医院治疗的80例脓毒性休克患者纳入研究对象，将患者分为观察组（40例）和对照组（40例），对照组脓毒性休克患者实施常规集束化治疗，观察组脓毒性休克患者治疗期间应用外周灌注指数指导，对比分析两组脓毒性休克患者液体复苏6 h前后的平均动脉压、心率、中心静脉血氧饱和度、血乳酸、中心静脉压改善水平和重症监护室死亡率和4周内死亡率、开始液体负平衡时间、24 h尿量、重症监护室时间、24 h输液量、机械通气时间、器官衰竭评分。结果 液体复苏前，两组脓毒性休克患者平均动脉压、心率、中心静脉血氧饱和度、血乳酸、中心静脉压比较差异无统计学意义（P>0.05），液体复苏6 h后，观察组心率、血乳酸水平略低于对照组，平均动脉压、中心静脉血氧饱和度、中心静脉压略高于对照组，但两组脓毒性休克患者以上各指标比较差异无统计学意义（P>0.05），观察组开始液体负平衡时间早于对照组（P<0.05），重症监护室死亡率和4周内死亡率低于对照组，但组间数据比较差异无统计学意义（P>0.05），观察组24 h尿量高于对照组，24 h输液量、器官衰竭评分均低于对照组（P<0.05），重症监护室时间、机械通气时间短于对照组（P<0.05）。结论 脓毒性休克患者早期集束化治疗过程中采用外周灌注指数指导更有利改善患者生命体征，降低死亡率，缩短患者恢复时间，作用显著。

Abstract:

Objective To analyze the peripheral perfusion indices for guiding fluid resuscitation in patients with septic shock.Methods Eighty patients with septic shock treated in Jinchang People's Hospital from May 2020 to August 2021 were enrolled in the study, and the patients were divided into an observation group (n=40) and a control group (n=40). The patients with septic shock in the control group were treated with conventional cluster therapy, and the patients with septic shock in the observation group were treated with peripheral perfusion index guidance during the treatment period. The mean arterial pressure, heart rate, central venous oxygen saturation, blood lactate, level of improvement in central venous pressure and intensive care unit mortality and mortality within 4 weeks, time to start negative fluid balance, 24-h urine output, intensive care unit time, 24-h fluid infusion, duration of mechanical ventilation and organ failure score between the two groups of septic shock patients before and after 6 hours of fluid resuscitation were compared and analyzed.Results Before fluid resuscitation, there were no significant differences in the mean arterial pressure, heart rate, central venous oxygen saturation, blood lactate, and central venous pressure between the two groups of patients with septic shock (P>0.05), whereas after 6 hours of fluid resuscitation, the heart rate and blood lactate level were slightly lower in the observation group than in the control group, and the mean arterial pressure, central venous oxygen saturation, and central venous pressure were slightly higher in the observation group than in the control group, however, there were no significant differences in all the above indicators between the two groups of patients with septic shock (P>0.05), the time to start negative fluid balance was significantly earlier in the observation group than in the control group (P<0.05), the rates of mortality in the intensive care unit and within 4 weeks were lower in the observation group than in the control group, but there was no statistical significance in the comparison of data between groups (P>0.05), in the observation group, the 24-h urine output was significantly higher than that of the control group, the 24-h fluid infusion volume and organ failure scores were significantly lower than those of the control group (P<0.05), and the duration of intensive care unit and mechanical ventilation was significantly shorter than that of the control group (P<0.05).Conclusions Early cluster therapy guided by peripheral perfusion index in septic shock patients is more beneficial in improving patients' vital signs, reducing mortality, and shortening patients' recovery time, with significant effects.