超声检查下腔静脉对外伤失血性休克的容量复苏意义.docVIP

超声检查下腔静脉对外伤失血性休克的容量复苏意义 摘要：目的：对ICU中外伤失血性休克患者分别进行下腔静脉超声检查和中心静脉压（CVP）监测，了解超声对外伤失血性休克的容量复苏价值。方法：选取ICU收治的30例外伤失血性休克患者，随机分为超声组和CVP组各15例。超声组以下腔静脉直径的呼吸变化率作为容量复苏标准，CVP组以传统的“2-5”容量负荷试验为标准，分别记录复苏后1 h、2 h、3 h的每小时尿量、平均动脉压和动脉乳酸值。完成复苏后再与临床复苏标准（尿量 2mL/kg/h，MAP 80mmHg且动脉乳酸值0.05无差异显著性。结论：下腔静脉超声检查和CVP监测对外伤失血性休克的容量复苏价值都是肯定的，但超声检查较CVP监测在容量复苏过程中的并发症发生率和补液效率上更具优势。 关 键 词：外伤失血性休克；下腔静脉；超声；ICU Abstract：Objective Through monitoring CVP（central venous pressure） and ultrasonic examination of inferior vena cava to the patients caused by traumatic hemorrhagic shock in ICU（intensive care unit）， we can understand the value of fluid resuscitation of ultrasonic examination. Methods： We selected 30 patients with traumatic hemorrhagic shock in ICU， who were randomly divided into ultrasonic examination group and CVP group， each group consists of 15 cases. In the group of ultrasound， we viewed the change rate of diameter and respiratory transformation rate of inferior vena cava as the standard of the fluid resuscitation. In the group of CVP， we took the traditional 2-5principle as the standard. The data of the urine volume per hour， mean arterial pressure and the arterial lactate in 1 hour， 2 hours， 3 hours were recorded after resuscitation. When we Completed resuscitations by the standard of the group of ultrasound and the group of CVP， we took Clinical recovery standard （urine volume 2mL/kg/h， MAP 80mmHg and arterial lactate 0.05）.The Results of the comparison had not statistical significance. Conclusions The curative effects of the group of ultrasound and CVP monitoring are both positive. However， the ultrasound group had less complications and higher rehydration efficiency than the CVP group. The ultrasonic inspection of inferior vena cava has more advantages than the traditional monitoring CVP of fluid resuscitation to the traumatic hemorrhagic shock in ICU. 　　Keywords：Traumatic hemorrhagic shock；Inferior vena cava；Ultrasound；ICU 外伤失血性休克患者的血流动力学指标以往多依赖于有创的监测，因其操作复杂且临床并发症相对较多，且有时不能及时地建立，为临床治疗带来了隐患。