超聲測量下腔靜脈變異度在顱腦術后合并急性呼吸窘迫綜合征患者液體管理中的臨床應用分析

葉先欽+許偉珍+莫建偉

【摘要】 目的：探討超聲測量下腔靜脈變異度在顱腦術后合并急性呼吸窘迫綜合征患者液體管理中的臨床應用價值。方法：選取2016年4月-2017年3月在ICU住院的顱腦術后合并急性呼吸窘迫綜合征的患者60例，將其隨機分為觀察組和對照組，各30例。觀察組通過超聲測量下腔靜脈變異度指導液體管理，對照組通過監測中心靜脈壓指導液體管理。結果：觀察組機械通氣時間、住ICU時間及血管活性藥物應用時間均明顯短于對照組（P<0.05）；觀察組MODS發生率、死亡率分別為6.67%、36.67%，均明顯低于對照組的23.33%、63.33%（P<0.05）；治療7 d后，觀察組PaO2/FiO2明顯高于對照組（P<0.05），而BNP水平、乳酸水平、呼吸頻率均明顯低于對照組（P<0.05）；兩組平均動脈壓比較，差異無統計學意義（P>0.05）；兩組治療第7天的各項指標與治療前比較，差異均有統計學意義（P<0.05）。結論：超聲測量下腔靜脈變異度指導顱腦術后合并急性呼吸窘迫綜合征患者液體管理可較準確判斷患者的容量狀態，明顯改善患者的血流動力學指標，具有較高的臨床應用價值。

【關鍵詞】 超聲測量下腔靜脈變異度； 顱腦術后合并急性呼吸窘迫綜合征； 液體治療

【Abstract】 Objective：To evaluate the clinical value of ultrasonography measurement of inferior vena cava variability in fluid management of patients with acute respiratory distress syndrome after craniocerebral operation.Method：60 patients with acute respiratory distress syndrome after craniocerebral operation who were hospitalized in ICU from April 2016 to March 2017 were selected，they were randomly divided into the observation group and the control group，30 cases in each group.The observation group guided the fluid management by ultrasonography to measure the variability of the inferior vena cava.The control group guided the management of the fluid by monitoring the central venous pressure.Result：The time of mechanical ventilation，ICU time and vasoactive drug application time of the observation group were significantly shorter than those of the control group（P<0.05）.The incidence of MODS and mortality of the observation group were 6.67% and 36.67%，they were significantly lower than 23.33% and 63.33% of the control group（P<0.05）.The level of BNP，lactate and respiratory rate of the observation group were significantly lower than those of the control group（P<0.05）.The mean arterial pressure between two groups were compared，the difference was not statistically significant（P>0.05）.The indexes of treatment for 7 days were compared with those before treatment between two groups，the differences were statistically significant （P<0.05）.Conclusion：Ultrasound measurement of inferior vena cava variability to guide postoperative craniotomy with acute respiratory distress syndrome in patients with liquid management can accurately determine the patients' capacity status，significantly improve the patients hemodynamic parameters，has a high clinical value.

【Key words】 Ultrasound measurement of inferior vena cava variability； Craniocerebral surgery combined with acute respiratory distress syndrome； Liquid therapy

First-authors address：Guangdong Provincial Nongken Center Hospital，Zhanjiang 524000，Chinaendprint

doi：10.3969/j.issn.1674-4985.2017.29.011

顱腦術后合并急性呼吸窘迫綜合征的患者多數為危重患者，其病情較復雜且具有變化性，多數存在血流動力學不穩定的現象，不恰當的液體復蘇治療將會導致患者的容量不足或容量過負荷狀態，進而產生嚴重的后果[1]。因此，對患者的容量狀態進行準確評估及采取有效的液體復蘇治療十分重要。相關研究發現，顱腦術后合并急性呼吸窘迫綜合征患者的液體正平衡會加重肺水腫，并延長機械通氣時間，提高病死率，有效的液體負平衡治療可明顯縮短患者的機械通氣時間與減低病死率[2]。傳統的液體治療方法是采用測量中心靜脈壓、尿量及血壓等，但該方法具有一定的局限性，故應采取更可靠、更敏感的指導治療方法。下腔靜脈是人體中最大的靜脈，收集了下肢、腹部、盆部的靜脈血，下腔靜脈變異度對診斷急性呼吸窘迫綜合征患者低血容量比傳統參數更敏感[3]。……