床旁超声监测每搏变异度在中度急性呼吸窘迫综合征患者治疗中的意义

樊益攀; 聂玲玲; 廖勃; 盛昌鼎; 严金霞

doi:10.13201/j.issn.1009-5918.2021.06.007

床旁超声监测每搏变异度在中度急性呼吸窘迫综合征患者治疗中的意义

- 南京医科大学附属江宁医院重症医学科(南京,211100)

详细信息

通讯作者: 严金霞,E-mail:yjx13770306030@163.com

中图分类号: R563.8

收稿日期: 2020-03-17

Significance of bedside ultrasound monitoring of stroke volume variation in the treatment of patients with moderate ARDS

- Department of Intensive Medicine, Jiangning Hospital Affiliated to Nanjing Medical University, Nanjing, 211100, China

More Information

Corresponding author: YAN Jinxia, E-mail: yjx13770306030@163.com

Received Date: 17 March 2020

摘要

摘要: 目的:探讨床旁超声监测每搏变异度(SVV)在中度ARDS患者治疗中的价值和意义。方法:选取2018年1月-2021年1月期间入住南京医科大学附属江宁医院重症监护病房(ICU)诊断为中度ARDS的患者60例。按随机数字表法分为两组,各30例。在采取相关基本治疗的基础上。对照组采用中心静脉压(CVP)指导液体管理。观察组采用床旁超声测量SVV指导液体管理。记录患者入科时、第24小时、第48小时、第72小时的APACHEⅡ评分、氧合指数(PaO₂/FiO₂)、肺静态顺应性(Clst)、气道平台压(Pplat)、心脏指数(CI)、动脉血乳酸(Lac)。并统计第1天、第2天、第3天单位体重去甲肾上腺素(NE)用量、液体入量及液体正平衡量。治疗结束后比较两组患者28 d存活率,无创呼吸机序惯治疗率,存活患者机械通气时间,ICU治疗时间。结果:①两组患者性别组成、年龄、入院时APACHEⅡ评分、PaO₂/FiO₂、PEEP、CVP、MAP等基本资料相比,均差异无统计学意义(P>0.05)。②观察组第48小时、第72小时PaO₂/FiO₂高于对照组;观察组第72小时Clst高于对照组,Pplat低于对照组,差异有统计学意义(P<0.05)。两组各时间点CI、Lac比较,差异无统计学意义(P>0.05)。③观察组第1天、第2天入液量及液体正平衡量少于对照组,差异有统计学意义(P<0.05);两组单位体重NE用量比较,差异无统计学意义(P>0.05)。④观察组与对照组28 d生存率、无创呼吸机序惯率比较,差异无统计学意义(P>0.05),但观察组机械通气时间、ICU治疗时间均少于对照组,差异有统计学意义(P<0.05)。结论:床旁超声测量SVV指导中度ARDS患者液体管理,入液量及液体正平衡更少,容量管理更精确。患者氧合、肺顺应性及气道平台压改善更显著。能缩短患者机械通气时间及ICU治疗时间。
- 每搏变异度 /
- 中度ARDS /
- 床旁超声 /
- 容量管理
Abstract: Objective: To explore the value and significance of bedside ultrasound monitoring of stroke volume variation(SVV) in the treatment of patients with moderate ARDS.Methods: Sixty patients who were admitted to the Intensive Care Unit(ICU) of Jiangning Hospital Affiliated to Nanjing Medical University with a diagnosis of moderate ARDS were selected From January 2018 to January 2021. According to the random number table method, they were divided into two groups, each with 30 cases. On the basis of relevant basic treatment, the control group used central venous pressure(CVP) to guide fluid management. The observation group used bedside ultrasound to measure SVV to guide fluid management. Record the APACHE Ⅱ score when the patient enters the department, 24 hours, 48 hours, 72 hours later, oxygenation index(PaO₂/FiO₂), static lung compliance(Clst), airway plateau pressure(Pplat), heart index(CI), arterial blood lactic acid(Lac). And count the amount of norepinephrine(NE) per unit body weight, fluid intake and positive fluid balance on the first, second, and third days. After treatment, the 28-day survival rate, non-invasive ventilator sequential treatment rate, mechanical ventilation time of the surviving patients, and ICU treatment time were compared between the two groups.Results:①There was no statistical difference between the two groups of patients in gender composition, age, APACHE Ⅱ score at admission, PaO₂/FiO₂, PEEP, CVP, MAP and other basic data(P>0.05).②PaO₂/FiO₂in the 48 h and 72 h of the observation group was higher than that of the control group; The 72 h Clst in the observation group was higher than that in the control group; Pplat of the observation group was lower than that of the control group, the difference was statistically significant(P<0.05). There was no significant difference in CI and Lac between the two groups at each time point(P>0.05).③The amount of fluid and the positive balance of fluid in the observation group on the 1 st and 2 nd day was less than that of the control group, The difference was statistically significant(P<0.05). There was no significant difference in NE dosage per unit weight between the two groups(P>0.05).④The 28-day survival rate and the non-invasive ventilator inertia rate between the observation group and the control group were not statistically different(P>0.05). However, the mechanical ventilation time and ICU treatment time in the observation group were shorter than those in the control group, the difference was statistically significant(P<0.05).Conclusion: Bedside ultrasound measurement of SVV guides fluid management in patients with moderate ARDS, with less fluid intake and positive fluid balance, and volume management is more accurate. The patient's oxygenation, lung compliance and airway plateau pressure improved more significantly. It can shorten the patient's mechanical ventilation time and ICU treatment time.
- stroke volume variation /
- moderate ARDS /
- bedside ultrasound /
- volume management

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