EVLWI联合ITBVI对感染性休克合并ARDS目标导向性补液治疗的指导作用

doi:10.3969/j.issn.1002-1949.2019.09.012

Chinese Journal of Critical Care Medicine

2019, Vol. 39

Issue (9): 864-868 DOI: 10.3969/j.issn.1002-1949.2019.09.012

Guiding role of EVLWI combined with ITBVI in septic shock with ARDS targeted oriented fluid replacement therapy

Bai Ling-xiao, Gong Mei, Liu Guo-juan

Intensive Care Unit, Inner Mongolia People′s Hospital, Huhhot 010017, China

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Abstract Objective To explore the guiding role of extravascular lung water index (EVLWI) combined with intrathoracic blood volume index (ITBVI) on target oriented fluid replacement therapy for the patients with septic shock and acute respiratory distress syndrome (ARDS). Methods Sixty patients with septic shock and ARDS were selected from April 2013 to May 2018 in our hospital. They were randomly divided into study group and control group, with 30 cases in each group. The patients in control group were given the target oriented fluid replacement therapy by monitoring central venous pressure (CVP), while the patients in study group were given the target oriented fluid replacement therapy by monitoring EVLWI and ITBVI by pulse indicator continuous cardiac output (PiCCO). The early recovery time of volume recovery and the standard-reaching rate of 6 h and 24 h between the 2 groups were compared, and the acute physiological and chronic health evaluation (APACHE)Ⅱ score, blood lactic acid (Lac), norepinephrine dosage and respiratory parameters (respiratory frequency, lung compliance, oxygenation index and end expiratory positive pressure level) were compared 1 d and 3 d after fluid replacement treatment, then the mechanical ventilation time, ICU time and 28-day mortality rate of the two groups were observed. Results The time of early volume recovery in the study group was (5.25±1.53) h, which was significantly shorter than that in the control group (6.54±1.86) h (P<0.05); and the 6-hour rate was 76.67%, which was significantly higher than that in the control group (46.67%, P<0.05). There was no significant difference in the 24-hour rate between the two groups (P>0.05). The APACHE Ⅱ score of critical patients in the study group was (20.37±3.89) after 3 days of treatment, while that in the control group was (23.16±4.05) after 3 days of treatment. There was a significant difference between the two groups after 3 days of treatment (P<0.05). There was no significant difference in respiratory parameters between the study group and the control group 1 day after treatment (P>0.05). The blood lactic acid, norepinephrine dosage, respiratory frequency and positive end-expiratory pressure levels in the study group after 3 days of treatment were (2.35±0.49) mmol/L,(0.61±0.13)μg/(kg·min), (18.47±3.61) beat/min and (5.04±1.09) cm H2O, respectively, which were all significantly lower than those on 1 d after treatment and ［（8.57±1.86）mmol/L、（1.12±0.34）μg/(kg·min)、（28.79±6.14）beat/min、（9.18±2.74）cm H2O］those of control group［(7.58±1.52)mmol/L、(1.09±0.27)μg/(kg·min)、（27.16±5.88）beat/min、(8.17±2.31)cm H2O］（P<0.05）. The pulmonary compliance and oxygenation index of the study group were (34.22±6.49) mL / cm H2O and (198.64±42.38) mm Hg, which were significantly higher than those of the control group ［(27.18±5.65)mL/cm H2O、(148.27±38.69)mm Hg］（P<0.05）. There was no significant difference between the control group and the treatment group (P>0.05). The mechanical ventilation time and the ICU time of the study group were (6.55±1.84) d and (11.68±2.96) d, respectively, which were significantly shorter than those of the control group［（12.14±3.19）d、（17.26±4.09）d］(P<0.05). The 28-day mortality in the study group was 20.0%, which was significantly lower than 46.67% in the control group (P<0.05). Conclusion EVLWI combined with ITBVI as a monitoring index in target oriented fluid replacement treatment of septic shock with ARDS patients can achieve recovery goals early, promote the recovery of the condition, improve the relevant parameters of respiratory, shorten the time of mechanical ventilation and stay at ICU time and reduce the 28-day mortality, which has a significant guiding effect of liquid management.

Key words： Extravascular lung water index (EVLWI) Intrathoracic blood volume index (ITBVI) Septic shock Acute respiratory distress syndrome (ARDS) Target oriented fluid replacement therapy

Corresponding Authors: Gong Mei, E-mail: nmgongmei@163.com

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Bai Ling-xiao,Gong Mei,Liu Guo-juan. Guiding role of EVLWI combined with ITBVI in septic shock with ARDS targeted oriented fluid replacement therapy[J]. Chinese Journal of Critical Care Medicine, 2019, 39(9): 864-868.

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http://www.cnemergency.org.cn/EN/10.3969/j.issn.1002-1949.2019.09.012 OR http://www.cnemergency.org.cn/EN/Y2019/V39/I9/864

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