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秦瑶, 尹万红, 曾学英, 等. 重症超声导向休克不同时期液体入量对结局的影响[J]. 四川大学学报(医学版), 2019, 50(6): 803-807.
引用本文: 秦瑶, 尹万红, 曾学英, 等. 重症超声导向休克不同时期液体入量对结局的影响[J]. 四川大学学报(医学版), 2019, 50(6): 803-807.
QIN Yao, YIN Wan-hong, ZENG Xue-ying, et al. Influence of Critical Care Ultrasound Oriented Fluid Management in Different Stages of Shock to the Outcome[J]. Journal of Sichuan University (Medical Sciences), 2019, 50(6): 803-807.
Citation: QIN Yao, YIN Wan-hong, ZENG Xue-ying, et al. Influence of Critical Care Ultrasound Oriented Fluid Management in Different Stages of Shock to the Outcome[J]. Journal of Sichuan University (Medical Sciences), 2019, 50(6): 803-807.

重症超声导向休克不同时期液体入量对结局的影响

Influence of Critical Care Ultrasound Oriented Fluid Management in Different Stages of Shock to the Outcome

  • 摘要:
      目的  探讨重症超声可视化病理生理导向的休克患者液体管理与预后的关系。
      方法  对一项重症超声导向的ICU患者休克治疗的前瞻随机对照研究的数据进行分析。试验组(77例)患者采用重症超声导向休克治疗(critical care ultrasound oriented shock treatment,CCUSOST)方案对休克患者不同时期的液体入量进行管理,并与传统的标准临床液体管理诊疗方法(对照组70例)进行比较,评估液体管理与预后的关系,以单因素和多因素logistic回归分析影响ICU病死的危险因素。
      结果  试验组患者和对照组患者基线指标一致(P>0.05),分组治疗后试验组患者ICU病死率较对照组低,差异有统计学意义(P < 0.05);试验组在休克稳定期和降阶梯入量和ICU病死率较对照组更少,且差异有统计学意义(P < 0.05);将纳入研究的ICU休克患者按是否死亡分为生存组(92例)和死亡组(55例),进行ICU病死的单因素分析,结果显示,急性生理和慢性健康(APACHE Ⅱ)评分、血乳酸(Lac)水平、每小时尿量、液体总入量、抢救期和优化期液体入量、降阶梯期和稳定期的液体入量两组差异有统计学意义(P < 0.05)。多因素分析显示,抢救期和优化期液体入量、稳定期和降阶梯期液体入量与乳酸、APACHE Ⅱ评分均是ICU病死结局的独立危险因素。
      结论  重症超声指导休克的液体管理,可以减少稳定期和降阶梯期的液体入量,并改善不良结局;无论是休克抢救期和优化期的液体入量,还是稳定期和降阶梯期的液体入量均与患者预后相关。

     

    Abstract:
      Objective  To investigate the relationship between fluid management oriented by critical care ultrasound and prognosis in patients with shock.
      Methods  We analyzed the data of a randomized controlled trial called Critical Care Ultrasound Oriented Shock Treatment (CCUSOST) in the Department of Critical Care Medicine, West China Hospital retrospectively. 77 patients in the critical care ultrasound oriented treatment group (experimental group) and 70 patients in the conventionally treated group as control were included in the statistics, to evaluate the relationship between fluid intake and prognosis. Univariate and multivariate logistic regression analyses were used to analyze risk factors for ICU mortality.
      Results  The baseline indexes of the patients in the experimental group and the control group were consistent. The ICU mortality of the experimental group was significantly lower than that of the control group (P < 0.05).The fluid intake in the stabilization and de-escalation phases was less than the the control group (P < 0.05). We divided these shock patients into survival group (92 cases) and non-survival (55 cases) according to whether they died in ICU, and the univariate analysis for ICU mortality showed that acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, SOFA score, Lac, hourly urine output, total fluid intake, fluid intake in the salvage and optimization stages, fluid intake in the stabilization and de-escalation stages were significantly different (P < 0.05) between survivers and non-survivers. Multivariete analysis showed that the fluid intake during the salvage and optimization phases, fluid intake in the stabilization and de-escalation phases were independent risk factors for ICU mortality.
      Conclusion  Critical care ultrasound oriented shock fluid management could reduce fluid intake of stabilization and de-escalation phases, and improved adverse outcome; whether the fluid intake during stabilization and de-escalation phases, or the fluid intake during the salvage and optimization phases, both were associated with patient prognosis.

     

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