液体负平衡对腹部外伤患者血流动力学指标变化与炎症因子浓度的影响及其相关因素分析

目的:探讨液体负平衡对腹部外伤患者血流动力学指标变化与炎症因子浓度的影响并分析其相关因素。方法:选取2015年10月-2018年9月期间在我院接受治疗的腹部外伤患者120例,以随机数字表法分为对照组(n=60)和研究组(n=60)。对照组患者采用常规的抗感染的治疗方法,研究组患者在对照组患者的基础上保持该组患者的液体负平衡,比较两组患者炎症因子水平、血流动力学指标、体内氧合情况及呼吸机机械通气状况,多因素Logistic回归分析研究组患者的生存率的影响因素。结果:两组患者治疗后白介素-6(IL-6)、动脉血氧分压差P(A-a)O2]均降低,且研究组低于对照组(P0.05),动脉血氧分压(PaO2)升高,且研究组高于对照组(P0.05)。两组患者脱机时平台压(Pplat)、呼气末正压(PEEP)、吸氧浓度(Fi O2)均降低,且研究组低于对照组(P0.05)。两组患者治疗后血管外肺水(EVLWI)降低,且研究组低于对照组(P0.05),心输出量(CO)、心指数(CI)与治疗前比较无差异(P0.05)。单因素分析结果显示,研究组患者生存率与患者的年龄、腹部创伤严重度评分(ISS)、手术前体温和碱剩余(BE)绝对值、ICU入室体温有关(P0.05),而与手术时间无关(P0.05)。Logistic回归分析结果显示,年龄、ISS、手术前BE绝对值、ICU入室体温均是研究组患者生存率的影响因素。结论:液体负平衡对腹部外伤患者的心肺功能具有一定的改善作用,可降低患者体内炎症因子的水平。年龄、ISS、ICU入室体温以及手术前BE绝对值均会影响腹部外伤患者的生存率。

Influence of Negative Fluid Balance on Hemodynamic Indexes and Inflammatory Factors Concentration in Patients with Abdominal Trauma and Analysis of Related Factors

ABSTRACT Objective: To explore the influence of negative fluid balance on hemodynamic indexes and inflammatory factor concentration in patients with abdominal trauma and analyze the relevant factors. Methods: 120 patients with abdominal trauma who were treated in our hospital from October 2015 September 2018 were selected, which were divided into the control group (n=60) and the study group(n=60) according to random number table method. Patients in the control group were treated with conventional anti infection therapy, patients in the study group maintained the negative fluid balance on the basis of the patients in the control group. The inflammatory factors, hemodynamic indexes, oxygenation, mechanical ventilation were compared between the two groups, and the influencing factors of survival rate in the study group were analyzed by Multivariate logistic regression analysis. Results: After treatment, interleukin-6 (IL-6) and arterial oxygen differential pressure (P(A-a)O₂) of the two groups were decreased, and the study group were lower than the control group (P<0.05), the arterial oxygen partial pressure (PaO₂) increased, and the study group was higher than the control group (P<0.05). The platform pressure (Pplat), positive end expiratory pressure (PEEP) and oxygen concentration (FiO2) decreased in both groups when they were off-lined, and the study group were lower than the control group (P<0.05). After treatment, the extravascular pulmonary water (EVLWI) decreased in both groups, and the study group were lower than the control group (P<0.05). Comparison with before treatment, there was no difference in cardiac output (CO) and cardiac index after treatment (P>0.05) The results of univariate analysis showed that the survival rate of the patients in the study group was related to the age of the patients, the abdominal trauma severity score (ISS), absolute value of body temperature and alkali residual (BE) before operation and the temperature of ICU entering the room (P<0.05), but it was not about the time of the operation (P>0.05). The results of Logistic regression analysis showed that age, ISS, absolute value of BE before operation and ICU temperature were the influence factors of the survival rate of patients with abdominal trauma. Conclusion: The negative fluid balance can improve the cardiopulmonary function and reduce the level of inflammatory factors in patients with abdominal trauma. Age, ISS, ICU temperature and absolute value of BE before operation will affect the survival rate of patients with abdominal trauma.