摘要
目的探讨血管外肺水(EVLW)联合中心静脉血氧饱和度(ScvO2)监测在急性呼吸窘迫综合征(ARDS)患者液体管理中的应用效果。方法选取佛山市禅城区中心医院2015年11月—2017年10月收治的ARDS患者60例,采用随机数字表法分为对照组与观察组,各30例。对照组依据传统治疗指南给予补液及利尿处理。观察组给予限制性液体管理,即监测EVLW及ScvO2,维持3 ml/kg<EVLW<7 ml/kg,使ScvO2>70%。比较两组入ICU时及治疗后1、2、3 d平均动脉压(MAP)、心率(HR)、急性肺损伤评分、氧合指数,并比较两组机械通气时间、住ICU时间及28 d生存率。结果入ICU时两组MAP、HR比较,差异无统计学意义(P>0.05);治疗后1、2、3 d观察组MAP高于对照组,HR低于对照组(P<0.05)。入ICU时及治疗后1、2、3 d,两组急性肺损伤评分比较,差异无统计学意义(P>0.05)。入ICU时及治疗后1、2 d,两组氧合指数比较,差异无统计学意义(P>0.05);观察组治疗后3 d氧合指数高于对照组(P<0.05)。观察组机械通气时间、住ICU时间短于对照组(P<0.05)。两组28 d生存率比较,差异无统计学意义(P>0.05)。结论EVLW联合ScvO2监测在ARDS患者液体管理中的应用效果良好,早期限制性液体管理可有效维持患者血流动力学稳定,改善氧合指数,促进患者康复。
Objective To investigate the effect of extravascular pulmonary water(EVLW)combined with central venous blood oxygen saturation(ScvO2)on fluid management in patients with acute respiratory distress syndrome(ARDS).Methods A total of 60 cases of patients with ARDS were selected from November 2015 to October 2017 in Foshan Chancheng Central Hospital,which were divided into control group and research group according to random number table,30 cases each of group.The control group was given rehydration and diuretic treatment according to the traditional treatment guidelines.In the observation group,EVLW and ScvO2 were monitored at the same time,maintaining 3 ml/kg<EVLW<7 ml/kg,making ScvO2>70%.The mean arterial pressure(MAP),heart rate(HR),acute lung injury score and oxygenation index were compared between the two groups at the time of admission to ICU and 1,2,3 days after treatment.Mechanical ventilation time,ICU time and 28 day survival rate were compared between the two groups.Results There was no significant difference in MAP and HR between the two groups at the time of admission to ICU(P>0.05);MAP in the observation group was higher than the control group,HR was lower than the control group 1,2,3 days after treatment(P<0.05).There was no significant difference in the acute lung injury score between the two groups at the time of admission to ICU and 1,2,3 days after treatment(P>0.05).There was no significant difference in the oxygenation index between the two groups at the time of admission to ICU and 1,2 days after treatment(P>0.05);the oxygenation index of the observation group was higher than the control group at 3 days after treatment(P<0.05).Mechanical ventilation time,ICU time in the observation group was shorter than the control group(P<0.05).There was no significant difference in 28 day survival rate between the two groups(P>0.05).Conclusion EVLW combined with ScvO2 has a good effect in the fluid management of ARDS patients.Early restrictive fluid management can effectively maintain the stability of hemodynamics,improve the oxygenation index and promote the recovery of patients.
作者
许瑞玉
XU Rui-yu(Department of Critical Care Medicine,Foshan Chancheng Central Hospital,Foshan 528000,China)
出处
《临床合理用药杂志》
2020年第12期11-13,共3页
Chinese Journal of Clinical Rational Drug Use
关键词
呼吸窘迫综合征
成人
液体管理
血管外肺水
中心静脉血氧饱和度
Respiratory distress syndrome,adult
Fluid management
Extravascular pulmonary water
Central venous blood oxygen saturation
