Effect of two volume responsiveness evaluation methods on fluid resuscitation and prognosis in septi

来源 :中华医学杂志(英文版) | 被引量 : 0次 | 上传用户:fengliguo1
下载到本地 , 更方便阅读
声明 : 本文档内容版权归属内容提供方 , 如果您对本文有版权争议 , 可与客服联系进行内容授权或下架
论文部分内容阅读
Background Few studies have reported the effect of different volume responsiveness evaluation methods on volume therapy results and prognosis.This study was carried out to investigate the effect of two volume responsiveness evaluation methods,stroke volume variation (SW) and stroke volume changes before and after passive leg raising (PLR-ASV),on fluid resuscitation and prognosis in septic shock patients.Methods Septic shock patients admitted to the Department of Critical Care Medicine of Zhejiang Hospital,China,from March 2011 to March 2013,who were under controlled ventilation and without arrhythmia,were studied.Patients were randomly assigned to the SVV group or the PLR-ASV group.The SVV group used the Pulse Indication Continuous Cardiac Output monitoring of SW,and responsiveness was defined as SW->12%.The PLR-ASV group used ASV before and after PLR as the indicator,and responsiveness was defined as ASV >15%.Six hours after fluid resuscitation,changes in tissue perfusion indicators (lactate,lactate clearance rate,central venous oxygen saturation (SCVO2),base excess (BE)),organ function indicators (white blood cell count,neutrophil percentage,platelet count,total protein,albumin,alanine aminotransferase,total and direct bilirubin,blood urea nitrogen,serum creatinine,serum creatine kinase,oxygenation index),fluid balance (6-and 24-hour fluid input) and the use of cardiotonic drugs (dobutamine),prognostic indicators (the time and rate of achieving early goal-directed therapy (EGDT) standards,duration of mechanical ventilation and intensive care unit stay,and 28-day mortality) were observed.Results Six hours after fluid resuscitation,there were no significant differences in temperature,heart rate,blood pressure,SpO2,organ function indicators,or tissue perfusion indicators between the two groups (P >0.06).The 6-and 24-hour fluid input was slightly less in the SW group than in the PLR-ASV group,but the difference was not statistically significant (P >0.05).The SW group used significantly more dobutamine than the PLR-ASV group (33.3% vs.10.7%,P =0.039).There were no significant differences in the time ((4.8±1.4) h vs.(4.3±1.3) h,P=0.142) and rate of achieving EGDT standards (90.0% vs.92.9%,P =0.698),or in the length of mechanical ventilation and ICU stay.The 28-day mortality in the SW group (16.7% (5/30)) was slightly higher than the PLR-ASV group (14.3% (4/28)),but the difference was not statistically significant (P =0.788).Conclusions In septic shock patients under controlled ventilation and without arrhythmia,using SW or PLR-ASV methods to evaluate volume responsiveness has a similar effect on volume therapy results and prognosis.The evaluation and dynamic monitoring of volume responsiveness is more important for fluid resuscitation than the evaluation methods themselves.Choosing different methods to evaluate volume responsiveness has no significant influence on the effect of volume therapy and prognosis.
其他文献
将加大截面加固法与体外预应力加固法相结合,提出了一种基于高强螺栓的有粘结体外预应力桥梁加固技术。实验结果也表明,本文采用的新型预加力高强螺栓以及通过摩擦力传递加固预
莱钢两座1 880 m3高炉均处于炉役后期,操作上通过大量使用长风口,上部调整装料制度,并不断开发炉料平铺技术,高炉顺行情况不断改善,实现了经济冶炼的目标,配料焦比降低了26 k
目的 探讨使用IFN和核苷(酸)类似物联合治疗HBeAg阳性慢性乙型肝炎获得HBsAg血清转换患者的临床特点和作用机制.方法 收集2001年1月至2007年5月使用IFN和拉米夫定或阿德福韦
目的比较溶栓与抗凝同时进行和先溶栓后抗凝两种方法治疗急性心肌梗死(AMI)的疗效。方法收集AMI病例201份。随机分为抗凝溶栓同时进行组(A组)和先溶栓后抗凝组治疗(B组),每组
结合两江特大桥实例,分析盖梁施工及其质量控制。
期刊
目的探讨螺旋CT图像重建在鼻内镜手术的应用价值。方法选取本院鼻内镜治疗的慢性鼻窦炎患者300例进行病变分型,根据图像重建方式随机分为常规CT检查组和CT图像重建组。术后6
本文通过对荣华二采区10
期刊