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分析
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摘要
目的:探讨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Pa O2/Fi O2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。
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 patient's hemodynamic parameters,has a high clinical value.
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 patient's hemodynamic parameters,has a high clinical value.
引文
[1]邓卓军,夏为,卞晓华,等.床旁超声在急性呼吸窘迫综合征患者液体管理中的应用[J].解放军医药杂志,2015,27(6):31-34.
[2]夏炳杰,施善阳.脉搏指示连续心排血量监测技术在感染性休克并急性呼吸窘迫综合征患者液体管理中的应用效果[J].实用心脑肺血管病杂志,2016,24(5):100-102.
[3]宋先荣,孟丽,张婉真,等.下腔静脉内径及变异度指导冠状动脉旁路移植术后患者液体管理的临床研究[J].中国实用医刊,2017,44(12):53-56.
[4]陈佳炜,蔡毅峰.血管外肺水指数和胸腔内血容积指数在脓毒性休克合并ARDS患者液体管理中的应用[J].中国医学创新,2017,14(2):67-70.
[5]曹关义,李泉,朱红岩,等.脉波轮廓温度稀释连续心排量测量技术在重症急性胰腺炎合并急性呼吸道窘迫综合征患者液体管理中的应用[J].中华危重症医学杂志(电子版),2016,9(2):96-100.
[6]陈盛奎,伍民生,刘品晶,等.脉波轮廓温度稀释连续心排量测量技术应用于败血症休克和急性呼吸窘迫综合征检测的效果[J].中国临床保健杂志,2015,18(2):204-207.
[7]赵春玲,王玉中,余丽亚,等.急性呼吸窘迫综合征患者的Pi CCO及液体管理策略[J].保健医学研究与实践,2015,12(6):31-35.
[8]金志鹏,王琪,苏军,等.脉搏指示连续心排血量监测在急性呼吸窘迫综合征患儿液体管理中的应用[J].中华实用儿科临床杂志,2017,32(6):439-441.
[9]胡千华,李泉,胡志强,等.超声测量下腔静脉内径变异度在急诊高龄患者围术期容量评估中的应用[J].江西医药,2017,52(6):561-562,564.
[10]董岩,杨立新,梁伟,等.下腔静脉内径呼吸变异度对休克患者容量反应性的评估价值[J].中国医学前沿杂志(电子版),2017,9(2):124-127.
[11]农委信,黄育强,孙薇薇.急性肾衰竭患者心脏指数与中心静脉压、下腔静脉管径呼吸变异指数关系的相关研究[J].中国中西医结合肾病杂志,2015,16(3):263-264.
[12]朱娜,马伟,张福帅.下腔静脉塌陷指数和中心静脉压检测在低血容量性休克患者液体管理中的应用[J].中国保健营养,2016,26(4):31.
[13]农委信,林孙龙,李乐.肾衰患者下腔静脉管径呼吸变异指数与心脏指数关系的相关研究[J].河北医学,2015,21(5):808-810.
[14]罗建,王丹琼,张伟文.腹腔压监测在脓毒症休克患者液体复苏中的临床意义[J].浙江医学,2015,37(9):728-731.
[15]孙昀,郑瑶,余维丽,等.呼气末正压对超声测量下腔静脉直径及变异度的影响[J].中华急诊医学杂志,2015,24(8):872-877.
[16]董岩,杨立新,梁伟,等.下腔静脉内径呼吸变异度对休克患者容量反应性的评估价值[J].中国医学前沿杂志(电子版),2017,9(2):124-127.
[17]程涛,张晓霞,彭鹏,等.下腔静脉内径呼吸变异度在感染性休克致急性肾损伤中的作用[J].中国急救医学,2016,36(1):30-34.
[18]步涨,潘纯,王俊,等.超声监测下腔静脉变异度对心功能不全患者困难撤机的预测价值[J].临床超声医学杂志,2017,19(6):371-374.
[19]王书豹,范永会.不同液体管理策略对急性呼吸窘迫综合征的预后影响研究[J].中外医疗,2016,35(22):26-28.
[20]王晓光.急性呼吸窘迫综合征患者通过呼吸支持、液体管理、抗炎和抗凝综合疗法治疗的效果评价[J].当代医学,2016,22(19):35-36.
[2]夏炳杰,施善阳.脉搏指示连续心排血量监测技术在感染性休克并急性呼吸窘迫综合征患者液体管理中的应用效果[J].实用心脑肺血管病杂志,2016,24(5):100-102.
[3]宋先荣,孟丽,张婉真,等.下腔静脉内径及变异度指导冠状动脉旁路移植术后患者液体管理的临床研究[J].中国实用医刊,2017,44(12):53-56.
[4]陈佳炜,蔡毅峰.血管外肺水指数和胸腔内血容积指数在脓毒性休克合并ARDS患者液体管理中的应用[J].中国医学创新,2017,14(2):67-70.
[5]曹关义,李泉,朱红岩,等.脉波轮廓温度稀释连续心排量测量技术在重症急性胰腺炎合并急性呼吸道窘迫综合征患者液体管理中的应用[J].中华危重症医学杂志(电子版),2016,9(2):96-100.
[6]陈盛奎,伍民生,刘品晶,等.脉波轮廓温度稀释连续心排量测量技术应用于败血症休克和急性呼吸窘迫综合征检测的效果[J].中国临床保健杂志,2015,18(2):204-207.
[7]赵春玲,王玉中,余丽亚,等.急性呼吸窘迫综合征患者的Pi CCO及液体管理策略[J].保健医学研究与实践,2015,12(6):31-35.
[8]金志鹏,王琪,苏军,等.脉搏指示连续心排血量监测在急性呼吸窘迫综合征患儿液体管理中的应用[J].中华实用儿科临床杂志,2017,32(6):439-441.
[9]胡千华,李泉,胡志强,等.超声测量下腔静脉内径变异度在急诊高龄患者围术期容量评估中的应用[J].江西医药,2017,52(6):561-562,564.
[10]董岩,杨立新,梁伟,等.下腔静脉内径呼吸变异度对休克患者容量反应性的评估价值[J].中国医学前沿杂志(电子版),2017,9(2):124-127.
[11]农委信,黄育强,孙薇薇.急性肾衰竭患者心脏指数与中心静脉压、下腔静脉管径呼吸变异指数关系的相关研究[J].中国中西医结合肾病杂志,2015,16(3):263-264.
[12]朱娜,马伟,张福帅.下腔静脉塌陷指数和中心静脉压检测在低血容量性休克患者液体管理中的应用[J].中国保健营养,2016,26(4):31.
[13]农委信,林孙龙,李乐.肾衰患者下腔静脉管径呼吸变异指数与心脏指数关系的相关研究[J].河北医学,2015,21(5):808-810.
[14]罗建,王丹琼,张伟文.腹腔压监测在脓毒症休克患者液体复苏中的临床意义[J].浙江医学,2015,37(9):728-731.
[15]孙昀,郑瑶,余维丽,等.呼气末正压对超声测量下腔静脉直径及变异度的影响[J].中华急诊医学杂志,2015,24(8):872-877.
[16]董岩,杨立新,梁伟,等.下腔静脉内径呼吸变异度对休克患者容量反应性的评估价值[J].中国医学前沿杂志(电子版),2017,9(2):124-127.
[17]程涛,张晓霞,彭鹏,等.下腔静脉内径呼吸变异度在感染性休克致急性肾损伤中的作用[J].中国急救医学,2016,36(1):30-34.
[18]步涨,潘纯,王俊,等.超声监测下腔静脉变异度对心功能不全患者困难撤机的预测价值[J].临床超声医学杂志,2017,19(6):371-374.
[19]王书豹,范永会.不同液体管理策略对急性呼吸窘迫综合征的预后影响研究[J].中外医疗,2016,35(22):26-28.
[20]王晓光.急性呼吸窘迫综合征患者通过呼吸支持、液体管理、抗炎和抗凝综合疗法治疗的效果评价[J].当代医学,2016,22(19):35-36.