限制性液体复苏对脓毒症休克患者预后的影响研究

摘要

目的 观察限制性液体复苏对脓毒症休克患者预后的影响.方法 将88例脓毒性休克患者随机分为2组.对照组40例参照《2012国际严重脓毒症及脓毒性休克诊疗指南》进行快速、充分液体复苏,观察组48例进行限制性液体复苏,比较2组复苏前及复苏后7 d 2组患者心率(HR)、平均动脉压(MAP),记录比较血乳酸、MODS评分、APACHEⅡ评分、28 d生存率、ICU住院时间、并发症发生率、心肝肾功能变化.结果 2组患者生存率比较差异未见统计学意义(P>0.05);治疗15 d、20 d、25 d、28 d后观察组生存率高于对照组,差异有统计学意义(P<0.05).2组患者治疗后APACHEⅡ评分及MODS评分均较复苏前下降,第7天差异有统计学意义(P<0.05);2组组间比较治疗第7天观察组APACHEⅡ评分及MODS评分低于对照组(P<0.05);第14天、28天观察组低于对照组,但差异无统计学意义(P>0.05).2组治疗后HR、MAP、CVP及乳酸水平均较本组治疗前降低,差异有统计学意义(P<0.05);2组组间比较观察组复苏后HR、MAP及乳酸水平低于对照组治疗后(P<0.05).观察组ICU入住时间及补液量低于对照组,利尿剂用量及升压药用量、24 h 乳酸清除率高于对照组,差异有统计学意义(P <0.05).2组治疗过程中ARDS、MODS、DIC发生率比较观察组低于对照组(P<0.05).2组复苏治疗后心功能及肝肾功能均较治疗前明显改善,差异有统计学意义(P<0.05),但观察组改善情况较对照组更为显著(P<0.05).结论 限制性液体复苏可改善脓毒症休克患者微循环,减少并发症的发生,减轻心肝肾脏器损伤,提高28 d生存率.%Objective To observe the effects of restrictive fluid resuscitation on the prognosis of patients with sepsis shock.Methods Eighty-eight patients with septic shock were randomly divided into control group (n=40) and observation group (n=48) according to 2012 International Guidelines for Management of Severe Sepsis and Septic Shock Diagnosis and Treatment Directory. The patients in control group were treated by rapid and sufficient fluid resuscitation,however,the patients in observation group were treated by restrictive fluid resuscitation. The heart rate (HR) and MAP before resuscitation and at 7d after resuscitation were observed and compared between two groups. In addition,the changes of blood lactate levels,MODS score,APACHE Ⅱ score,28-day survival rate,length of staying in ICU, incidence rate of complications, and changes of heart, liver and kidney function were observed and compared between two groups. Results There was no significant difference in survival rate between the two groups(P>0.05). The survival rates at 15d,20d,25d and 28d after treatment in observation group were significantly higher than those in control group(P<0.05). The APACHEⅡscores and MODS scores were decreased in both groups after treatment,as compared with those before resuscitation (P<0.05),there were significant differences in the scores at 7d after treatment between two groups(P<0.05). The APACHEII scores and MODS scores at 7d after treatment in observation group were significantly lower than those in control group(P<0.05),and both scores at 14d and 28d after treatment in observation group were lower than those in control group, but there were no significant differences between two groups(P>0.05). The HR,MAP,CVP,and lactic acid levels after treatment in both groups were significantly lower than those before treatment(P<0.05). Moreover HR,MAP,and lactate levels after resuscitation in observation group were significantly lower than those in control group (P<0.05). The length of staying in ICU and fluid infusion volume in observation group were significantly lower than those in control group (P <0.05),however,the diuretic dose, vasopressor dose,and lactic acid clearance rate in 24 hours in observation group were significantly higher than those in control group(P<0.05). The incidence rates of ARDS,MODS and DIC in observation group were significantly lower than those in control group (P<0.05). Moreover,the cardiac function as well as liver and kidney function were significantly improved in both groups after resuscitation (P<0.05),moreover the improvement degree in observation group was more obvious than that in control group (P<0.05). Conclusion The restrictive fluid resuscitation is beneficial to improve the microcirculation of patients with sepsis shock,which can reduce the incidence of complications,alleviate the danmage of heart,liver and kidney and improve 28-day survival rate of patients.