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目的以床旁超声监测感染性休克患者下腔静脉内径(IVC)、左室舒张末期容积(LVEDV),指导患者液体复苏,探讨床旁超声指导感染性休克患者液体复苏的临床价值。方法选择该院重症医学科感染性休克患者112例,采用床旁超声指导液体管理,容量控制机械通气下行床旁超声测量呼气末、吸气末下腔静脉最大内径(IVCmax)、最小径(IVCmin),计算出下腔静脉呼吸变异指数(RVI),测量左室舒张末期容积(LVEDV);测CVP,PiCCO导管法测定胸腔内血容量指数(ITBVI)、血管外肺水指数(EVLWI)。液体复苏后再次行床旁超声、PiCCO测定上述数值,比较液体复苏前后IVC、RVI、LVEDV、ITBVI、EVLWI变化,并行相关性分析。结果液体复苏后超声测得IVCmax(1.69±0.31)cm、IVCmin(1.44±0.23)cm、LVEDV(122±41)ml较复苏前(1.24±0.23)cm、(0.65±0.18)cm、(106±34)ml增高,RVI(15.8±4.3)%较复苏前(46.9±6.5)%下降,与复苏前比较差异均有统计学意义(均P<0.05);IVC、LVEDV与ITBVI、EVLWI显著正相关(r=0.786、0.826、0.693、0.735、0.679、0.694、0.614、0.629、0.647、0.703、0.584、0.598,P均<0.01),RVI与ITBVI、EVLWI负相关(r=-0.635、-0.487、-0.527、-0.469,P均<0.05)。结论床旁超声监测感染性休克患者IVC、LVEDV可有效评估患者血容量,为临床液体复苏提供指导依据。
Objective To evaluate the clinical value of bedside ultrasound in monitoring the IVC and LVEDV in patients with septic shock to guide liquid resuscitation and discuss the clinical application of bedside ultrasound in the induction of fluid resuscitation in patients with septic shock. Methods One hundred and twelve patients with septic shock in the intensive care department of the hospital were enrolled in this study. Bedside ultrasound was used to guide the management of fluid. Mechanical ventilation was used to measure the end-expiratory, end-inspiratory IVCmax and minimum diameter IVCmin). The venous respiratory index (RVI) was calculated and the left ventricular end-diastolic volume (LVEDV) was measured. The ITBVI and EVLWI were measured by CVP and PiCCO catheter method. Bedside ultrasound was performed again after fluid resuscitation. The above values were measured by PiCCO. The changes of IVC, RVI, LVEDV, ITBVI and EVLWI before and after liquid resuscitation were compared and analyzed in parallel. Results The IVCmax (1.44 ± 0.31) cm, LVEDV (122 ± 41) ml were significantly higher than those before the resuscitation (1.24 ± 0.23 cm, (0.65 ± 0.18) cm, (P <0.05). There was a significant positive correlation between IVC, LVEDV and ITBVI and EVLWI (P <0.05). The mean value of RVI (15.8 ± 4.3)% was significantly lower than that before resuscitation (46.9 ± 6.5)% (r = 0.786,0.826,0.693,0.735,0.679,0.694,0.614,0.629,0.647,0.703,0.584,0.598, P <0.01). There was a negative correlation between RVI and ITBVI and EVLWI (r = -0.635, -0.487, - 0.527, -0.469, P <0.05). Conclusion Bedside ultrasound monitoring of septic shock in patients with IVC, LVEDV can effectively assess the patient’s blood volume, provide guidance for clinical fluid recovery.