扩展的目标导向超声心动图方案对感染性休克患者的影响

目的 研究扩展的目标导向超声心动图方案(eFATE)对感染性休克病人的影响.方法 入选2009年1月至2011年1月北京协和医院综合重症医学科(ICU)83例感染性休克病人,分为应用心脏超声eFATE组和常规组;eFATE方案为:24 h可用的目标导向心脏超声评估流程,在应用心脏超声eFATE组,每次病人主管医生或值班医生认为病人需要血流动力学评估时均在应用常规评估手段时同时应用本方案,常规组仪用常规评估手段.方案应用研究期为人组后1周.记录即刻及之后1周内每6 h的心率、平均动脉压(MAP)、中心静脉压(CVP)、CO、心脏指数(CI)、体循环阻力指数(SVRI)、Scv02、APACHEII评分、动脉血乳酸水平以及用药情况,尤其强心药物.记录6、24、72 h和1周的液体入量情况,记录ICU病死率和28 d病死率.结果 应用eFATE组24 h达标率明显高于常规治疗组,对6 h达标率无影响.应用eFATE组6、24 h和1周治疗液体入量明显少于对照组.应用eFATE组发现感染性休克病人的心肌抑制早于对照组.应用eFATE方案组病死率与对照组比较差异无统计学意义.结论 eFATE有助于提高感染性休克病人24 h目标指导治疗达标率,减少治疗中液体入量,并发现感染性休克病人的心肌抑制及滴定处理.eFATE对预后的影响需进一步设计研究.超声心动图在感染性休克的正确评价具有重要作用.

Abstract：

Objective To investigate the impact of extended focus assessed transthoracic echocardiography(eFATE)in septic shock patients.Methods A total of 83 septic shock patients were recruited.And they were divided into the eFATE and routine groups.In the routine group,the patients were assesged by routine methods.And in the eFATE group,the following parameters of central venous pressure (CVP),mean arterial pressure(MAP),cardiac index(CI),stroke volume index(SVI)and ScvO2(central venous oxygen saturation)were measured routinely.The PiCCO(pulse indicator continuous cardiac output)method was employed when needed.All parameters and the others[acute physiology and chronic health evaluation II(APACHE II)& lactate]were recorded every 6 h.At 6,24,72 h and 1 W,the fluid intake volumes were recorded.All values were analyzed by statistic methods.And the mortality rates of intensive care unit and Day 28 were recorded.Results In the eFATE group,the 24 h targeting rate was markedly hisber than the routine group.Yet there was no effect on the 6 h targeting rate.In the eFATE group,the fluid intake volumes at 6,24 h and 1 W were markedly lowered than those of the control group.And the myocardial inhibition occurred earlier versus the control group.There wag no difference in mortality rate between two groups.Conclusion eFATE plays an important role in the correct assessment of septic shock patients.But its prognostic impact remains to be further defined.

Impact of extended focus assessed transthoracic echocardingraphy protocol in septic shock patients

Objective To investigate the impact of extended focus assessed transthoracic echocardiography(eFATE)in septic shock patients.Methods A total of 83 septic shock patients were recruited.And they were divided into the eFATE and routine groups.In the routine group,the patients were assesged by routine methods.And in the eFATE group,the following parameters of central venous pressure (CVP),mean arterial pressure(MAP),cardiac index(CI),stroke volume index(SVI)and ScvO2(central venous oxygen saturation)were measured routinely.The PiCCO(pulse indicator continuous cardiac output)method was employed when needed.All parameters and the others[acute physiology and chronic health evaluation II(APACHE II)& lactate]were recorded every 6 h.At 6,24,72 h and 1 W,the fluid intake volumes were recorded.All values were analyzed by statistic methods.And the mortality rates of intensive care unit and Day 28 were recorded.Results In the eFATE group,the 24 h targeting rate was markedly hisber than the routine group.Yet there was no effect on the 6 h targeting rate.In the eFATE group,the fluid intake volumes at 6,24 h and 1 W were markedly lowered than those of the control group.And the myocardial inhibition occurred earlier versus the control group.There wag no difference in mortality rate between two groups.Conclusion eFATE plays an important role in the correct assessment of septic shock patients.But its prognostic impact remains to be further defined.