脑氧饱和度监测指导脑灌注对感染性休克患者血流动力学及脑钠肽的影响

Effect of cerebral perfusion guided by cerebral oxygen saturation monitoring on hemodynamics and brain natriuretic peptide of patients with septic shock

    摘要
  • 摘要: 目的 探讨脑氧饱和度监测指导脑灌注在感染性休克治疗中的效果。方法 选取2018年1-7月在天津海滨人民医院治疗的感染性休克患者97例,给予早期复苏目标导向治疗,根据是否给予脑氧饱和度监测指导分为研究组（n=50）和对照组（n=47）,其中研究组在对照组的基础上给予脑氧饱和度监测指导,观察两组复苏72 h后复苏液体量、液体平衡量、尿量指标,以及治疗效果的差异。结果 研究组第72 h的复苏液体量、液体正平衡量分别为7 020.60（3 600.00,10 200.50）ml和1 240.22（760.50,2 010.22）ml明显低于对照组（P<0.05）,而尿量为5 700.20（3 010.22,8 540.43）ml明显高于对照组（P<0.05）;研究组复苏72 h的平均动脉压（mean arterial pressure,MAP）、中心静脉压（central venous pressure,CVP）和中心静脉血氧饱和度（central venous oxygen saturation,ScvO2）分别为（84.10±10.44）mmHg、（15.22±1.82）mmHg和（76.20±3.22）%明显高于对照组（P<0.05）;研究组复苏72 h的乳酸和脑钠肽（brain natriuretic peptide,BNP）分别为（1.21±0.34）mmol/L和321.02（190.38,540.02）ng/L明显低于对照组（P<0.05）;研究组入住ICU时间为（9.82±1.82）d较对照组明显缩短（P<0.05）,两组患者28 d病死率比较差异无统计学意义。结论 脑氧饱和度监测指导脑灌注在感染性休克治疗中有较好的效果,值得临床使用。

     

    Abstract: OBJECTIVE To explore the effect of cerebral perfusion guided by cerebral oxygen saturation monitoring on treatment of the patients with septic shock. METHODS A total of 97 patients with septic shock who were treated with early resuscitation target-oriented therapy in Tianjin Coastal People′s Hospital from Jan 2018 to Sep 2018 were enrolled in the study and were divided into the study group with 50 cases and the control group with 47 cases according to the factor whether they were treated under the guidance of cerebral oxygen saturation monitoring.The study group was treated under the guidance of cerebral oxygen saturation monitoring on the basis of the treatment of the control group.Resuscitation fluid volume, fluid balance volume and urine volume indexes as well as therapeutic effect were observed and compared between the two groups of patients after the resuscitation for 72 hours. RESULTS The recovery liquid volume and positive liquid balance of the study group were respectively 7 020.60（3 600.00,10 200.50）ml and 1 240.22（760.50,2 010.22）ml after the resuscitation for 72 hours, significantly lower than those of the control group（P＜0.05）; while the urine volume of the study group was 5 700.20（3 010.22,8 540.43）ml, significantly higher than that of the control group（P＜0.05）.The mean arterial pressure（MAP）, central venous pressure（CVP） and central venous oxygen saturation（ScvO2） of the study group were respectively（84.10±10.44）mmHg,（15.22±1.82）mmHg and（76.20±3.22）% after the resuscitation for 72 hours, significantly higher than those of the control group（P＜0.05）.The levels of lactic acid and brain natriuretic peptide（BNP） of the study group were respectively（1.21±0.34）mmol/L and 321.02（190.38,540.02）ng/L after the resuscitation for 72 hours, significantly lower than those of the control group（P＜0.05）.The length of ICU stay of the study group was（9.82±1.82）days, significantly shorter than that of the control group（P＜0.05）.There was no significant difference in the 28-day mortality rate between the two groups of patients. CONCLUSION The cerebral perfusion guided by cerebral oxygen saturation monitoring can achieve remarkable effect on treatment of the patients with septic shock, and it is worthy to be promoted in clinical practice.

     

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