魏宏 涂汉坤 李朝阳

[摘要]目的 探討应用经胸心脏超声指导感染性休克患者围术期液体复苏的应用效果。方法 选取2015年5月～2016年12月我院收治的64例感染性休克且需要手术的患者作为研究对象，采取随机数字表法将其分为研究组和参照组，每组各32例。参照组采取脉波指示剂连续心排血量法（PiCCO）监测指导液体复苏，研究组采取经胸心脏超声监测指导液体复苏，比较两组患者液体复苏1、2、3 h时的心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）、复苏液体量、尿量以及液体正平衡量，并比较两组的血管活性药物用量、ICU入住时间、肺水肿发生率以及7 d病死率等各项指标。结果 复苏2 h时两组患者MAP、CVP均明显高于复苏1 h（P<0.05）；复苏 2、3 h时，研究组的复苏液体量、液体正平衡量均明显少于参照组，复苏2 h时研究组的尿量明显多于参照组，差异均有统计学意义（P<0.05）；两组患者血管活性药物用量比较，差异无统计学意义（P>0.05）；研究组患者的ICU入住时间、肺水肿发生率以及7 d病死率均低于参照组，差异有统计学意义（P<0.05）。结论 应用经胸心脏超声能更准确地指导感染性休克手术患者进行液体复苏，减少并发症，且无创，具有显著的应用效果，值得临床进一步推广。

[关键词]经胸心脏超声；连续心排血量监测；感染性休克；液体复苏

[中图分类号] R445.1 [文献标识码] A [文章编号] 1674-4721（2018）7（c）-0079-04

[Abstract] Objective To evaluate the effect of transthoracic echocardiography on perioperative fluid resuscitation in patients with septic shock. Methods From May 2015 to December 2016， 64 patients with septic shock requiring surgery in our hospital were selected as the subjects， and divided into study group and reference group by random table number method， 32 cases in each group. The reference group was monitored to guide fluid resuscitation by pulse wave indicator continuous cardiac output method （PiCCO）， while the study group was monitored by transthoracic echocardiography to guide fluid resuscitation. The heart rate （HR）， mean arterial pressure （MAP）， central venous pressure （CVP）， fluid volume， urine volume and positive fluid balance were compared between the two groups at 1， 2 and 3 h after fluid resuscitation. The dosage of vasoactive drugs， the time of ICU occupancy， the incidence of pulmonary edema and the mortality of 7 d were compared between the two groups. Results At 2 h after resuscitation， the CVP of MAPV in both groups was significantly higher than that in 1 h after resuscitation （P<0.05）. At 2 and 3 h after resuscitation， the resuscitation liquid volume and positive fluid balance in the study group was significantly fewer than that in the reference group. Urine volume in the study group was significantly more than that in the reference group at 2 h after resuscitation， the differences were statistically significant （P<0.05）. There was no significant difference in the dosage of vasoactive drugs between the two groups （P>0.05）. However， the ICU occupancy time， the incidence of pulmonary edema and the mortality of 7 d in the study group were lower than those in the control group， the differences were statistically significant （P<0.05）. Conclusion The application of transthoracic echocardiography can more accurately guide the fluid resuscitation in patients undergoing septic shock surgery. It can reduce complications and is non-invasive. It has significant application effect， which is worthy of further clinical promotion.

[Key words] Transthoracic echocardiography； Continuous cardiac output monitoring； Septic shock； Fluid resuscitation

感染性休克是围术期的常见病症，患者容易发生急性心、肺功能受损，造成组织灌注不足、多器官衰竭，最终导致患者死亡[1-2]。液体复苏是治疗感染性休克患者的首选治疗措施[3-4]。但是感染性休克患者的血流动力学往往失去稳定，因此选择适宜的方式监测患者的血流动力学指标，指导液体复苏对减低感染性休克患者的死亡率具有重要意义[5]。目前脉波指示剂连续心排血量法（PiCCO）是临床常用的液体复苏监测方式，但是PiCCO属于有创方法，在临床应用存在一定的局限性[6]。而随着床旁超声技术的不断成熟，经胸心脏超声在临床应用中也逐渐广泛。……