床旁实时超声在急性呼吸窘迫综合征患者液体管理中的应用价值

摘要

目的:探讨床旁实时超声在急性呼吸窘迫综合征(ARDS)患者液体管理中的应用价值.方法:收集医院重症科2016年1月至2016年8月收治的88例ARDS患者,按入院顺序分为对照组和观察组各44例.所有患者均接受有创机械通气治疗控制肺水肿,对照组治疗中通过持续监测中心静脉压(CVP)指标进行液体管理,观察组根据床旁超声肺部监测情况指导液体管理.比较两组机械通气时间、ICU住院时间和治疗1周前后心率(HR)、CVP、呼气末气道正压(PEEP)、氧合指数、血乳酸以及急性生理与慢性健康评分Ⅱ (APACHE Ⅱ)评分变化等.结果:观察组机械通气时间、ICU室住院时间分别较对照组低,有统计学差异(P＜0.05);两组治疗1周后HR、PEEP、血乳酸、APACHE Ⅱ评分较治疗前均有明显降低,氧合指数显著升高,有统计学差异(P＜0.05),且观察组治疗后上述指标变化更为显著(P＜0.05);两组30d死亡率相较差异无统计学意义(P＞0.05),但观察组治疗后肺外脏器功能受损发生率较对照组显著较低,有统计学差异(P＜0.05).结论:床旁实时超声指导ARDS患者液体管理是一种安全、有效的容量评估手段.%Objective:To investigate the value of bedside real-time ultrasound in fluid management of patients with acute respiratory distress syndrome (ARDS).Methods:88 cases of ARDS patients admitted to our hospital from January 2016 to August 2016 were collected and divided into control group and observation group according to their admission sequence,each with a total of 44 cases.All patients received invasive mechanical ventilation to control pulmonary edema,control group treated by continuous monitoring of central venous pressure (CVP) fluid management indicators,the observation group based on bedside ultrasonic monitoring of lung fluid management guidance.Comparison of two groups of mechanical ventilation time,ICU stay and 1 weeks before and after treatment of heart rate (HR),CVP,positive end expiratory pressure (PEEP),oxygenation index,blood lactic acid and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score change etc..Results:Mechanical ventilation time in the observation group,room ICU,hospital stay were lower than the control group,there was significant difference (P＜0.05);the two groups after 1 weeks of treatment,HIR,PEEP,blood lactate and APACHE Ⅱ scores were lower than before the treatment,the oxygenation index increased significantly,there were statistically significant differences (P＜0.05),the observation group after treatment,the changes of the above indexes was more significant (P＜0.05);the two group of 30d mortality compared with no significant difference (P＞0.05),but the observation group after treatment of extrapulmonary organ dysfunction incidence significantly lower than in the control group,there was significant difference (P＜ 0.05).Conclusion:Bedside real-time ultrasound guidance for the management of ARDS patients is a safe and effective method for volume assessment.