吴馨馨 彭开毅 张文滔 黄祥卫

【摘要】 目的：评价重症超声在重症肺炎血流动力学治疗中的应用价值。方法：选取2014年7月-2017年6月茂名市人民医院重症医学科收治的78例重症肺炎患者，按照先、后入院顺序分为研究组和对照组，每组39例，给予对照组重症肺炎患者常规血流动力学治疗，对研究组患者实施重癥超声检查，综合重症超声检查结果为研究组患者制定血流动力学治疗方案，比较两组累计液体量、液体正平衡量、尿量、血管活性药物用量、肺水肿发生率、CRRT介入治疗率及平均住ICU的时间和平均治疗费用。结果：治疗后研究组患者液体复苏6、24、48、72 h累计液体量、液体正平衡量均明显少于对照组，复苏6、24、48、72 h尿量多于对照组，比较差异均有统计学意义（P<0.05）；研究组患者去甲肾上腺素（NE）用量少于对照组，肺水肿发生率、CRRT介入治疗率均低于对照组，比较差异均有统计学意义（P<0.05）；研究组患者平均住ICU的时间短于对照组，平均治疗费用少于对照组，比较差异均有统计学意义（P<0.05）。结论：根据重症超声检查结果指导重症肺炎的血流动力学治疗，能有效评估患者复苏的容量反应性，减少肺水肿发生率及AKI发生风险，且有利于减轻患者经济负担。

【关键词】 重症超声； 重症肺炎； 血流动力学； 容量反应性

doi：10.14033/j.cnki.cfmr.2018.7.004 文献标识码 A 文章编号 1674-6805（2018）07-0008-03

【Abstract】 Objective：To evaluate the value of severe ultrasound in hemodynamics of severe pneumonia.Method：From July 2014 to June 2017，78 patients with severe pneumonia treated in Maoming peoples Hospital Intensive Care Unit were divided into study group and control group according to the order of first admission and the later admission，39 cases in each group.The patients in control group were given routine treatment of severe pneumonia.The patients in study group were given severe ultrasound examination，combined with severe ultrasound results for the study group to develop hemodynamic treatment program.The cumulative amount of fluid，fluid balance，urine output，amount of vasoactive drugs，incidence of pulmonary edema，rate of interventional treatment of CRRT，average time of ICU，and average cost of treatment were compared between the two groups.Result：After treatment，the volume of fluid and fluid balance in the study after 6 h，24 h，48 h and 72 h of resuscitation were significantly less than those of the control group，the urine output of 6，24，48 and 72 h after resuscitation were more than those of the control group，the differences were statistically significant（P<0.05）.The dosage of Norepinephrine（NE） in the study group was less than that in the control group，the incidence of pulmonary edema and CRRT intervention rates of the study group were lower than those of the control group，the difference was statistically significant（P<0.05）.The average time of ICU in the study group was shorter than that in the control group，the average cost of treatment was less than that of the control group，and the differences were statistically significant（P<0.05）.Conclusion：According to the results of severe ultrasound guided hemodynamic therapy of severe pneumonia，can effectively assess the capacity of patients with recovery of reactivity，reduce the incidence of pulmonary edema and AKI risk，and help to reduce the financial burden on patients.

【Key words】 Severe ultrasound； Severe pneumonia； Hemodynamics； Capacity Reactivity

First-authors address：Maoming Peoples Hospital，Maoming 525000，China

重症肺炎具有预后不佳的特点，实现该疾病的早期诊治十分必要，其中血流动力学治疗方面，如何有效进行正确的液体复苏至关重要。现阶段，超声技术已经在重症疾病患者的临床诊治中得到广泛应用，2013年5月，中国重症超声研究组在四川成都成立，并在全国各地举办重症超声培训班，推广重症超声理念[1-2]。某院经实践发现，常规超声不同于传统超声，在重症疾病临床诊治中发挥的作用更突出。为明确重症超声在重症肺炎血流动力学治疗中的应用价值，茂名市人民医院重症医学科选取78例重症肺炎患者作为研究对象开展课题研究，现将研究内容报道如下。……