|
|
|
|
|
| Effects of different fluid management strategies on left ventricular diastolic function in patients with septic shock after early goal-directed therapy |
| Xia Jia-ding, Duan Li-juan, Zhang Kun, Ma Xiao-bin, Zhao Kai-feng |
| Intensive Care Unit, Affiliated Hospital of Chengde Medical College, Chengde 067000, China |
|
|
|
|
Abstract Objective To observe and explore the effects of different fluid management strategies on the left ventricular diastolic function in patients with septic shock after early goal-directed resuscitation. Methods As a prospective cohort study, 56 patients with septic shock admitted to the Department of Intensive Care Unit of Affiliated Hospital of Chengde Medical College during June 2014 to June 2016. The patients were randomly divided into two groups after early fluid resuscitation. Each group was of 28 cases. Treatment group was received restrictive fluid management strategies after early goal-directed therapy, but control group was continued to carry out open liquid management. Then liquid cumulative balance was observed with different periods in two groups. As the evaluation index of left ventricular diastolic function, the ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity(E/e′) was observed. Meanwhile, the myocardial injury markers like troponin-I(cTnI) and N-proBNP were observed at 6th hour, 3rd day and 7th day in ICU.Results The fluid balance of two groups was positive during 0~6 hours. However, the fluid balance in treatment group was significantly lower than that of control group in length of ICU stay(P＜0.05). The incidence of left ventricular diastolic dysfunction in patients was 39.3%, greater than other types of cardiac dysfunction, such as left ventricular systolic dysfunction(23.2%). Compared with control group, E/e′ and cTnI in treatment group were decreased significantly in 3rd and 7th day, as well as NT-proBNP in 7th day(P＜0.05). Compared with that in 6 th hour, E/e′, cTnI and NT-proBNP of two groups were significantly increased in 3rd day(P＜0.05). E/e′, cTnI and NT-proBNP of treatment group were significantly decreased in 7th day compared to that in 3rd day(P＜0.05); while E/e′, cTnI of control group were decreased not significantly, even NT-proBNP was increased(P＞0.05).Conclusion Left ventricular diastolic dysfunction existed widely in patients with septic shock, which could be improved significantly through the implementation of restrictive fluid management strategy. The effect of myocardial injury and myocardial depression was reduced, and the prognosis was improved.
|
|
Received: 22 December 2016
|
|
Corresponding Authors:
Zhao Kai-feng, E-mail: zhaokf5580@163.com
|
|
|
|
|
|
|
Address: 1 North 2nd Street,
Zhongguancun, 