李杰敏 成艳芙 黎玉珠 吕运好 林钦汉

【摘要】 目的：探讨床旁超声指导在脓毒症休克早期液体复苏治疗中的临床应用价值。方法：选取2017年11月-2019年11月本院收治的80例脓毒症休克患者作为研究对象，根据监测方法不同分为观察组（n=49例）与对照组（n=31）。对照组早期液体复苏治疗选择常规脉搏指示剂持续心排血量法（PICCO）指导，观察组早期液体复苏在床旁超声指导下进行，比较两组治疗前及治疗后6、12 h平均静脉压（MAP）、中心静脉压（CVP）、中心静脉血氧饱和度（ScvO2）、血乳酸等指标变化，并记录两组液体复苏达标率、液体复苏用量及不良反应发生情况。结果：两组治疗前血流动力学指标比较，差异均无统计学意义（P>0.05）;两组治疗后6、12 h血流动力学指标均明显优于治疗前（P<0.05），但两组治疗后6 h血流动力学指标比较，差异均无统计学意义（P>0.05），观察组治疗后12 h血流动力学指标均优于对照组（P<0.05）。观察组治疗后6、12 h液体复苏达标率均高于对照组，且液体复苏用量均少于对照组，差异均有统计学意义（P<0.05）。观察组不良反应发生率低于对照组，差异有统计学意义（字2=3.892，P=0.048）。结论：将床旁超声用于指导脓毒症休克早期液體复苏治疗，可有效改善患者血流动力学指标及达标率，不仅能减少液体复苏用量，还能减少并发症发生风险，显著提升患者预后效果，安全有效，值得临床推广应用。

【关键词】 床旁超声指导 脓毒症 休克 早期液体复苏 血流动力学

Clinical Study on Bedside Ultrasound Guidance in Early Fluid Resuscitation of Septic Shock/LI Jiemin， CHENG Yanfu， LI Yuzhu， LYU Yunhao， LIN Qinhan. //Medical Innovation of China， 2021， 18（24）： -188

[Abstract] Objective： To investigate the clinical application value of bedside ultrasound guidance in the early fluid resuscitation treatment of septic shock. Method： A total of 80 patients with septic shock in our hospital from November 2017 to November 2019 were selected and divided into the observation group （n=49） and the control group （n=31） according to different monitoring methods. The control group was guided by routine pulse indicator continuous cardiac output （PICCO） in early fluid resuscitation treatment， and the observation group was guided by bedside ultrasound guidance. The changes of MAP， CVP， ScvO2 and blood lactate were recorded before and after 6 and 12 h of treatment between two groups， the rate of fluid resuscitation， the amount of fluid resuscitation and the incidence of adverse reactions were recorded between two groups. Result： There were no significant differences in hemodynamic indexes between two groups before treatment （P>0.05）. The hemodynamic indexes of two groups at 6 and 12 h after treatment were significantly better than those of before treatment （P<0.05）， however， there were no significant differences in hemodynamic indexes between two groups at 6 h after treatment （P>0.05）， the hemodynamic indexes of the observation group at 12 h after treatment were better than those of the control group （P<0.05）. The standard rate of liquid resuscitation in the observation group at 6 and 12 h after treatment were higher than those in the control group， and the amount of liquid resuscitation was less than that in the control group， the differences were statistically significant （P<0.05）. The incidence of adverse reactions in the observation group was lower than that in the control group， the difference was statistically significant （字2=3.892， P=0.048）. Conclusion： Bedside ultrasound guidance in early fluid resuscitation treatment of septic shock can effectively improve the hemodynamic indexes and compliance rate of patients， not only can reduce the amount of fluid resuscitation， but also reduce the risk of complications， significantly improve the prognosis of patients， it is safe and effective， which is worthy of clinical application.

[Key words] Bedside ultrasound guidance Sepsis Shock Early fluid resuscitation Hemodynamics

First-author’s address： Qingyuan People’s Hospital， Qingyuan 511518， China

doi：10.3969/j.issn.1674-4985.2021.24.046

脓毒症是临床中较为常见的感染性疾病之一，主要是由细菌、真菌、病……