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床旁超声检查在脓毒症和脓毒性休克管理中的作用

Role of Point-of-Care Ultrasonography for the Management of Sepsis and Septic Shock.

作者信息

Shrestha Gentle Sunder, Srinivasan Shrikanth

机构信息

Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.

Department of Critical Care Medicine, Manipal Hospital, Dwarka, New Delhi, India.

出版信息

Rev Recent Clin Trials. 2018;13(4):243-251. doi: 10.2174/1574887113666180412165405.

Abstract

BACKGROUND

Sepsis and septic shock remain a major cause of morbidity and mortality globally. In recent years, the outcome of patients with sepsis and septic shock has gradually improved, in part due to early recognition and timely appropriate management. Bedside physical examination can be of limited value to identify the source of infection and to decide appropriate management. Moreover, the clinical status of these patients can change rapidly, as a part of disease progression or in response to treatment or intervention.

METHODS

Research articles, review papers and online contents related to point-of-care ultrasound for the management of patients with sepsis and septic shock were reviewed.

RESULTS

Point-of-care ultrasonography can be a valuable bedside tool to rapidly identify the potential source of infection and associated organ dysfunction. It can also help to guide management to predict fluid responsiveness by assessing the variation of inferior venacava with respiration, ventricular size and aortic flow variation. Response to various interventions like a fluid challenge or administration of inotropes can be assessed at the bedside. Point-of-care ultrasound can also enhance safety and increase the success of bedside procedures like central venous cannulation and drainage of pleural effusion.

CONCLUSION

Bedside ultrasound can help to individualize management of patients with sepsis and septic shock and may potentially improve patient outcome.

摘要

背景

脓毒症和脓毒性休克仍然是全球发病和死亡的主要原因。近年来,脓毒症和脓毒性休克患者的预后逐渐改善,部分原因是早期识别和及时恰当的管理。床旁体格检查在识别感染源和决定恰当管理方面的价值有限。此外,这些患者的临床状况可能会迅速变化,这是疾病进展的一部分,或是对治疗或干预的反应。

方法

对与床旁超声用于脓毒症和脓毒性休克患者管理相关的研究文章、综述论文和在线内容进行了综述。

结果

床旁超声检查可以成为一种有价值的床旁工具,用于快速识别潜在的感染源和相关器官功能障碍。它还可以通过评估下腔静脉随呼吸的变化、心室大小和主动脉血流变化来帮助指导管理,以预测液体反应性。可以在床旁评估对各种干预措施(如液体冲击或使用血管活性药物)的反应。床旁超声还可以提高安全性,并增加诸如中心静脉置管和胸腔积液引流等床旁操作的成功率。

结论

床旁超声有助于对脓毒症和脓毒性休克患者进行个体化管理,并可能改善患者的预后。

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