天津医药

天津医药 ›› 2015, Vol. 43 ›› Issue (2): 203-206.doi: 10.11958/j.issn.0253-9896.2015.02.024

• 应用研究 • 上一篇    下一篇

每搏量变异度在老年脓毒性休克患者中的应用

王志,汤卫兵△， 刘野   

  1. 长春市解放军第208医院重症医学科 （邮编130062）
  • 收稿日期:2014-03-21 修回日期:2014-09-27 出版日期:2015-02-15 发布日期:2015-02-27
  • 通讯作者: 汤卫兵 E-mail:wangzhi1971@126.com
  • 基金资助:
    吉林省科技发展计划项目重点科技攻关项目 （20130206034SF）

Application of stroke volume variation in directing management of elderly septic shock patients

  • Received:2014-03-21 Revised:2014-09-27 Published:2015-02-15 Online:2015-02-27

PDF (PC)

3873

摘要： 摘要： 目的 探讨每搏量变异度(SVV)在老年脓毒性休克患者中的应用。方法 将进行机械通气的老年脓毒性休克患者 28 例分为常规组 13 例和 SVV 指导组 15 例， 常规组根据中心静脉压 （CVP） 指导容量复苏， SVV 指导组根据 SVV、 心输出量（CO） 指导容量复苏。观察 2 组患者复苏时间、 复苏后血乳酸、 氧合指数、 CVP、 平均动脉压 （MAP）、 N 端尿钠肽前体 （NT-proB⁃ NP） 等变化， 机械通气时间、 24 h 内左心功能不全发生率， 28 d 发生多器官功能障碍综合征 （MODS） 和死亡情况， 记录 SVV 指导组复苏前后血流动力学参数 SVV、 CO、 外周血管阻力 （SVR） 的变化。结果 SVV 指导组复苏时间短于常规组(t=3.83)， 乳酸、 NT-proBNP 较常规组下降(t 分别为 3.20 和 12.32， P < 0.05)， 氧合指数较常规组升高 （t=3.01,P < 0.05）。2 组左心功能不全、 MODS 及病死率差异无统计学意义 （P 分别为 0.198、 0.410 和 0.372）。SVV 指导组复苏后 CO、 SVV 较复苏前改善 （P<0.05）。结论 SVV 能更好地指导老年脓毒性休克患者的容量复苏。

关键词: 休克, 脓毒性, 老年人, 每搏量变异度, 复苏术

Abstract: Abstract： Objective To investigate the application of stroke volume variation (SVV) in directing management of elderly septic shock patients. Methods Patients who were diagnosed with elderly septic shock and supported with mechanical ventilation were in⁃ cluded (n=28). They were divided into control group (n=13) and SVV group (n=15). Volume recovery was directed by CVP (central ve⁃ nous pressure ) in control group and by SVV and CO (cardiac output) in SVV guoup respectively. Blood lactate, oxidation index, CVP , MVP, NT-proBNP, time of recovery, the length relying on mechanical ventilation and Vigileo parameters were compared after volume resuscition. During the period of treatment, the incidence of acute left ventricle dysfunction within 24 hours, MODS within 28 days and mortality rates of all causes were compared between these two groups. Changes in SVV, cardiac output (CO) and systemic vascular re⁃ sistance (SVR) in SVV group before and after resustation were recorded. Results Blood lactate acid and NT-proBNP were significant⁃ ly lower in SVV group compared with those in control group whereas oxidation index in SVV group were significantly higher than that of control group. The time of resuscitation and the duration relying on mechanical ventilation were shorter in SVV group than those in control group. On the contrary, the incidence of acute left ventricle dysfunction，MODS and all mortality rates were not significantly different between these two groups. There were significant differences between hemodynamic variables such as SVV, CO in SVV group before and after resuscitation. Conclusion SVV may direct volume resuscitation more effective in elderly septic shock than CVP does.

Key words: hock, septic, elderly, stroke volume variation, resuscitation