叶先钦+许伟珍+莫建伟

【摘要】 目的：探討超声测量下腔静脉变异度在颅脑术后合并急性呼吸窘迫综合征患者液体管理中的临床应用价值。方法：选取2016年4月-2017年3月在ICU住院的颅脑术后合并急性呼吸窘迫综合征的患者60例，将其随机分为观察组和对照组，各30例。观察组通过超声测量下腔静脉变异度指导液体管理，对照组通过监测中心静脉压指导液体管理。结果：观察组机械通气时间、住ICU时间及血管活性药物应用时间均明显短于对照组（P<0.05）；观察组MODS发生率、死亡率分别为6.67%、36.67%，均明显低于对照组的23.33%、63.33%（P<0.05）；治疗7 d后，观察组PaO2/FiO2明显高于对照组（P<0.05），而BNP水平、乳酸水平、呼吸频率均明显低于对照组（P<0.05）；两组平均动脉压比较，差异无统计学意义（P>0.05）；两组治疗第7天的各项指标与治疗前比较，差异均有统计学意义（P<0.05）。结论：超声测量下腔静脉变异度指导颅脑术后合并急性呼吸窘迫综合征患者液体管理可较准确判断患者的容量状态，明显改善患者的血流动力学指标，具有较高的临床应用价值。

【关键词】 超声测量下腔静脉变异度； 颅脑术后合并急性呼吸窘迫综合征； 液体治疗

【Abstract】 Objective：To evaluate the clinical value of ultrasonography measurement of inferior vena cava variability in fluid management of patients with acute respiratory distress syndrome after craniocerebral operation.Method：60 patients with acute respiratory distress syndrome after craniocerebral operation who were hospitalized in ICU from April 2016 to March 2017 were selected，they were randomly divided into the observation group and the control group，30 cases in each group.The observation group guided the fluid management by ultrasonography to measure the variability of the inferior vena cava.The control group guided the management of the fluid by monitoring the central venous pressure.Result：The time of mechanical ventilation，ICU time and vasoactive drug application time of the observation group were significantly shorter than those of the control group（P<0.05）.The incidence of MODS and mortality of the observation group were 6.67% and 36.67%，they were significantly lower than 23.33% and 63.33% of the control group（P<0.05）.The level of BNP，lactate and respiratory rate of the observation group were significantly lower than those of the control group（P<0.05）.The mean arterial pressure between two groups were compared，the difference was not statistically significant（P>0.05）.The indexes of treatment for 7 days were compared with those before treatment between two groups，the differences were statistically significant （P<0.05）.Conclusion：Ultrasound measurement of inferior vena cava variability to guide postoperative craniotomy with acute respiratory distress syndrome in patients with liquid management can accurately determine the patients' capacity status，significantly improve the patients hemodynamic parameters，has a high clinical value.

【Key words】 Ultrasound measurement of inferior vena cava variability； Craniocerebral surgery combined with acute respiratory distress syndrome； Liquid therapy

First-authors address：Guangdong Provincial Nongken Center Hospital，Zhanjiang 524000，Chinaendprint

doi：10.3969/j.issn.1674-4985.2017.29.011

颅脑术后合并急性呼吸窘迫综合征的患者多数为危重患者，其病情较复杂且具有变化性，多数存在血流动力学不稳定的现象，不恰当的液体复苏治疗将会导致患者的容量不足或容量过负荷状态，进而产生严重的后果[1]。因此，对患者的容量状态进行准确评估及采取有效的液体复苏治疗十分重要。相关研究发现，颅脑术后合并急性呼吸窘迫综合征患者的液体正平衡会加重肺水肿，并延长机械通气时间，提高病死率，有效的液体负平衡治疗可明显缩短患者的机械通气时间与减低病死率[2]。传统的液体治疗方法是采用测量中心静脉压、尿量及血压等，但该方法具有一定的局限性，故应采取更可靠、更敏感的指导治疗方法。下腔静脉是人体中最大的静脉，收集了下肢、腹部、盆部的静脉血，下腔静脉变异度对诊断急性呼吸窘迫综合征患者低血容量比传统参数更敏感[3]。……