中国血液净化

中国血液净化 ›› 2024, Vol. 23 ›› Issue (06): 431-435.doi: 10.3969/j.issn.1671-4091.2024.06.007

• 临床研究 • 上一篇    下一篇

下腔静脉内径呼吸变异率在脓毒症患者早期连续性肾脏替代治疗容量管理中的临床意义

孙 立    杨玉芳    赵 群   

  1. 314000 嘉兴，1嘉兴市第二医院ICU
  • 收稿日期:2023-12-27 修回日期:2024-03-09 出版日期:2024-06-12 发布日期:2024-06-12
  • 通讯作者: 赵群 E-mail:isunli1986@163.com
  • 基金资助:
    嘉兴市科技计划项目(2020AD30120)

Clinical significance of respiratory variation rate of inferior vena cava in volume management for early continuous renal replacement therapy in patients with sepsis

SUN Li, YANG Yu-Fang, ZHAO Qun   

  1. Department of Critical Care Medicine, The second Hospital of Jiaxing City, Jiaxing 314000, China
  • Received:2023-12-27 Revised:2024-03-09 Online:2024-06-12 Published:2024-06-12
  • Contact: 314000 嘉兴，1嘉兴市第二医院ICU E-mail:isunli1986@163.com

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摘要： 目的 探讨超声监测下腔静脉内径呼吸变异率指导容量管理在脓毒性患者早期连续性肾脏替代治疗(continuous renal replacement therapy，CRRT)中的意义。 方法  选择因脓毒症在嘉兴市第二医院重症监护病房(intensive care unit，ICU)住院治疗并拟实施CRRT治疗的患者为研究对象，随机分为对照组及超声组，对照组使用常规方法进行CRRT液体管理，超声组通过超声监测下腔静脉内径呼吸变异率指导CRRT液体管理。收集患者一般资料，比较2组患者CRRT上机前及治疗24、48及72小时的血流动力学和血气分析指标，分析2组患者临床预后指标。 结果 共纳入60例患者，对照组及超声组各30例，与对照组相比较，CRRT治疗早期，超声组血管活性药物使用剂量更少(F=1.255，P＜0.001)、中心静脉压更低(F=18.618，P＜0.001)。预后指标表明：超声组CRRT治疗时间更少(t=3.103，P=0.004)、血管活性药物使用时间更短(t=4.775，P＜0.001)，28天肾脏替代治疗脱离率更高(χ2=4.593，P=0.032)。 结论  使用超声监测下腔静脉内径呼吸变异率指导脓毒症患者CRRT早期容量管理，可以改善患者早期血流动力学指标及临床预后。

关键词: 超声, 下腔静脉, 脓毒症, 连续性肾脏替代治疗, 容量

Abstract: Objective  To explore the application of respiratory variability of inferior vena cava diameter for early volume management of continuous renal replacement therapy (CRRT) in sepsis shock patients.   Methods The sepsis patients hospitalized in the Intensive Care Unit (ICU) of the Second Hospital of Jiaxing City and planned to be treated with CRRT were selected as the research objects. They were randomly divided into control group and ultrasound group. In the ultrasound group, the respiratory variation rate of inferior vena cava diameter was monitored by ultrasound to guide fluid management during CRRT. General data of the patients were collected, and the hemodynamics and blood gas indexes of the two groups were compared before CRRT and 24, 48 and 72 hours after CRRT. Clinical prognosis indexes of the two groups were analyzed.   Result   A total of 60 patients were enrolled in this study, including 30 in the control group and 30 in the ultrasound group. There were no significant differences in the general clinical data between the two groups (P＞0.05). Compared with the control group, the dose of vasoactive drugs and the central venous pressure were lower (F=1.255 and 18.618, P＜0.001) in the early stage of CRRT of the ultrasound group. In addition in the ultrasound group, the prognostic indicators showed that the durations of CRRT and vasoactive drug treatment were shorter (t=3.103 and 4.775, P=0.004 and ＜0.001),  and the rate of withdrawal from CRRT at the 28th day was higher (χ2=4.593, P=0.032).  Conclusion  The use of ultrasound to monitor the respiratory variation rate of inferior vena cava diameter can guide the early volume management of CRRT in septic patients, so that the early hemodynamic indexes and the clinical prognosis are improved in these patients

Key words: Ultrasonic, Inferior vena cava, Sepsis, Continuous renal replacement therapy, Capacity

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