老年患者脓毒性休克液体复苏速度与预后的关系

目的探讨老年患者脓毒性休克液体复苏过程中输液速度与预后的相关性。方法回顾性分析92例严重感染病人液体复苏效果。按液体复苏期间的输液速度分为慢速组（〈500ml/h）和快速组（≥500ml/h）,并对两组患者的心率、有创及无创血压、血氧饱和度、呼吸、中心静脉压（CVP）、每小时尿量、尿比重、血乳酸、ScVO2及有无发生肺水肿、急性心功能不全、急性肾功能不全、MODS和7天死亡率、28天死亡率及入住ICU时间、住院时间等指标进行分析比较。结果两组患者在液体复苏过程中CVP和MAP两项指标比较无统计学意义。慢速组的尿量达标时间耗时较长（P〈0.05）;ScVO2及乳酸清除率比较无明显差异。快速组对液体的需求量多,而应用血管活性药物的病例数则少于慢速组;发生肺水肿、急性心功能不全的比例高于慢速组（P〈0.05）。两组急性肾功能不全的发生率相近,但慢速组出现MODS的例数少（P〈0.05）。7天死亡率和28天死亡率比较,慢速组低于快速组,但无统计学意义。两组患者住院时间无显著统计学意义,入住ICU时间慢速组明显短于快速组（P〈0.05）。结论在脓毒性休克复苏过程中不可一味靠加快输液速度来保证组织灌注,尤其对于老年患者,更应控制单位时间内的输液量,避免给储备能力较差的心功能造成更大的负担。在保证主要脏器灌注的情况下可以适当应用血管活性药物。

Correlation of infusion rate and prognosis in the fluid resuscitation of elderly patients with septic shock

Objective To investigate the correlation of the infusion rate and prognosis in the fluid resuscitation of elderly patients with septic shock.Methods Retrospective analysis the result of fluid resuscitation in 92 cases septic shock.According to the fluid resuscitation speed,all patients were divided into groups slow ground(<500 ml/h) and fast ground(≥500 ml/h),measured the heart rate,blood pressure,blood oxygen saturation,breathing,central venous pressure(CVP),every hour urine,urine specific gravity,blood lactic acid and ScVO2.Analysis indexs such as the rate of pulmonary edema,acute cardiac dysfunction,acute renal insufficiency,MODS,seven days mortality and twenty-eight days mortality,record the length of time in ICU and in hospital.Results In the process of fluid resuscitation,no significant differences were found in CVP and MAP.It took a longer time in slow group to reach index of urine volume(P<0.05).There also were no different in the indexs of blood lactic acid and ScVO2,the demand of liquid in the fast group was more than slow group,but need less vasoactive drugs.A higher rate of pulmonary edema and acute cardiac dysfunction were found in the fast group(P<0.05).No significant differences were found in acute renal insufficiency.For prognostic indicators,there were lower rates of MODS(P<0.05),seven days and twenty-eight days mortality in slow group,but no statistical significance was found,also the time in hospital,but the length of time in ICU was lower in slow group.Conclusion For elderly patients with septic shock,we must control unit time fluid amount in the process of fluid resuscitation,because of their heart reserve function have droped.Under the premise of main viscera perfusion,we must avoid to give more big burden to heart.