无创心排量监测结合重症超声在成人脓毒性休克患者液体复苏中的应用价值OA
Application Value of Non-invasive Cardiac Output Monitoring Combined with Critical Ultrasound in Fluid Resuscitation of Adult Patients with Septic Shock
目的:分析无创心排量监测结合重症超声在成人脓毒性休克患者液体复苏中的应用价值,为成人脓毒性休克患者的液体管理提供临床依据.方法:采用前瞻性研究方法,选取龙游县人民医院2023 年 7 月—2025 年 5 月收治的 189 例成人脓毒性休克患者,按照随机数字表法分为对照组和观察组.对照组(n=94)实施常规液体复苏治疗,观察组(n=95)在对照组基础上结合重症超声指导液体复苏治疗,并同步进行无创心排量监测.对比两组治疗 6、24、72 h 后的液体复苏达标率,治疗前及治疗 72 h后的血流动力学指标[MAP、中心静脉压(CVP)、HR]及实验室指标[乳酸(Lac)、降钙素原(PCT)、CRP、PLT、Cr、TBIL],以及预后相关指标和新发多器官功能障碍综合征(MODS)发生率.结果:观察组治疗 6、24、72 h 后的液体复苏达标率高于对照组(P<0.05);观察组治疗 72 h 后的 MAP、CVP 高于对照组,心率低于对照组(P<0.05);观察组治疗 72 h 后的 Lac、PCT、CRP、Cr、TBIL 低于对照组,PLT 高于对照组(P<0.05);观察组机械通气时间、ICU 住院时长短于对照组,24 h 输液量、24 h 去甲肾上腺素用量少于对照组(P<0.05);观察组新发 MODS 发生率低于对照组(P<0.05).结论:无创心排量监测结合重症超声应用于成人脓毒性休克患者的液体复苏治疗,可有效提高液体复苏达标率,改善患者血流动力学状态,减轻炎症反应,改善预后,降低新发MODS 发生率.
Objective:To analyze the application value of non-invasive cardiac output monitoring combined with critical ultrasound in fluid resuscitation of adult patients with septic shock,and to provide clinical evidence for fluid management of adult patients with septic shock.Method:A prospective study was conducted,189 adult patients with septic shock who were admitted to Longyou County People's Hospital from July 2023 to May 2025 were selected and divided into a control group and an observation group according to the random number table method.The control group(n=94)received conventional fluid resuscitation treatment,the observation group(n=95)received fluid resuscitation treatment guided by critical ultrasound on the basis of the control group,and synchronous non-invasive cardiac output monitoring was performed.The fluid resuscitation achievement rate at 6,24,and 72 hours after treatment,hemodynamic indicators[MAP,central venous pressure(CVP),HR]and laboratory indicators[lactate(Lac),procalcitonin(PCT),CRP,PLT,Cr,TBIL]before treatment and after 72 h of treatment,prognosis-related indicators,and the incidence of new-onset multiple organ dysfunction syndrome(MODS)were compared between the two groups.Result:The fluid resuscitation achievement rate of the observation group at 6,24,and 72 hours after treatment were higher than those of the control group(P<0.05).The MAP and CVP of the observation group at 72 h after treatment were higher than those of the control group,and the HR was lower than that of the control group(P<0.05).The Lac,PCT,CRP,Cr and TBIL of the observation group at 72 h after treatment were lower than those of the control group,while PLT was higher than that of the control group(P<0.05).The mechanical ventilation time and ICU length of stay of the observation group were shorter than those of the control group,and the 24 h fluid infusion volume and 24 h norepinephrine dosage were less than those of the control group(P<0.05).The incidence of new-onset MODS of the observation group was lower than that of the control group(P<0.05).Conclusion:The application of non-invasive cardiac output monitoring combined with critical ultrasound in fluid resuscitation of adult patients with septic shock can effectively improve the fluid resuscitation achievement rate,improve the hemodynamic status of patients,reduce inflammatory responses,improve prognosis,and lower the incidence of new-onset MODS.
蔡惠芳;袁灵敏;杨勤
浙江中医药大学研究生院 浙江 杭州 310053||龙游县人民医院重症监护室 浙江 龙游 324400龙游县人民医院重症监护室 浙江 龙游 324400浙江中医药大学研究生院 浙江 杭州 310053||龙游县人民医院重症监护室 浙江 龙游 324400
医药卫生
无创心排量监测重症超声成人脓毒性休克液体复苏血流动力学预后
Non-invasive cardiac output monitoringCritical ultrasoundAdultSeptic shockFluid resuscitationHemodynamicsPrognosis
《中国医学创新》 2026 (25)
6-11,6
浙江省医药卫生科技计划项目(2024XY205)
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