脓毒症患者早期液体复苏后液体管理的研究.doc

脓毒症患者早期液体复苏后液体管理的研究 　　[摘要]目的 为有效对早期液体复苏后的脓毒症患者实施液体管理，探究不同液体管理方式对患者疾病治疗的影响。 方法 本次研究对象为我院2014年6月～2016年6月期间诊断为脓毒症的42例患者，临床分组采用随机数字表法将患者分为常规、治疗两组，每组均为21例。所有患者在早期液体复苏后，常规组给予二级液体管理，治疗组根据中心静脉压、每小时尿量、BE、SCVO2给予液体管理，对比两组患者重症监护时间、药物使用时间、通气辅助时间、气管插管发生率，统计临床病死率，比较液体管理后两组患者心率、呼吸频率变化。 结果 常规组气管插管率、死亡发生率为47.6%、14.3%，明显高于治疗组23.8%、4.8%，治疗组患者死亡率低、气管插管发生少，差异有统计学意义（P0.05）；治疗组较常规组ICU费用低、机械通气时间短、重症监护时间少，差异有统计学意义（P0.05）；治疗组患者心率、呼吸频率恢复均优于常规组，差异有统计学意义（P0.05）。 结论 脓毒症患者在早期液体复苏后以中心静脉压、每小时尿量、BE、SCVO2监测来指导液体使用量，患者恢复快、住院时间少。 　　[关键词]液体复苏；中心静脉压；脓毒症；液体管理 　　[中图分类号] R459.7 [文献标识码] B [文章编号] 2095-0616（2017）15-255-03 　　[Abstract] Objective To effectively manage fluid resuscitation in patients with early fluid resuscitation， and to explore the treatment of patients with different fluid management. Methods 42 patients with sepsis diagnosed in our hospital from June 2014 to June 2016 were selected as the study object. They were divided into two groups according to the random number table with 21 cases in each. All patients were treated with early fluid resuscitation. Patients in routine group were given two level liquid management. Patients in treatment group were treated with manage fluid administration according to central venous pressure， hourly urine volume， BE， and SCVO2. The time of intensive care， the time of drug use， the time of ventilatory assistance and the rate of tracheal intubation， and the clinical fatality rate， and the changes of heart rate and respiratory rate in the two groups after liquid administration were compared. Results The trachea intubation rate and the mortality rate of the conventional group were 47.6% and 14.3%， which were significantly higher than those of the treatment group with 23.8% and 4.8%， and the mortality rate of the treatment group was lower and the trachea intubation was less（P0.05）. Compared with the conventional group， the treatment group had lower ICU cost， shorter mechanical ventilation time， and less intensive care time， the difference was statistically si