Qin Yao, Yin Wan-Hong, Zeng Xue-Ying, Zou Tong-Juan, Li Yi, Zhou Ran, Kang Yan, Wang Xiao-Ting
Emergency Department and Intensive Care Unit, West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu 610041, China.
Department of Intensive Care Unit, West China Hospital, Sichuan University, Chengdu 610041, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2019 Dec;50(6):803-807.
To investigate the relationship between fluid management oriented by critical care ultrasound and prognosis in patients with shock.
We analyzed the data of a randomized controlled trial called Critical Care Ultrasound Oriented Shock Treatment (CCUSOST) in the Department of Critical Care Medicine, West China Hospital retrospectively. 77 patients in the critical care ultrasound oriented treatment group (experimental group) and 70 patients in the conventionally treated group as control were included in the statistics, to evaluate the relationship between fluid intake and prognosis. Univariate and multivariate logistic regression analyses were used to analyze risk factors for ICU mortality.
The baseline indexes of the patients in the experimental group and the control group were consistent. The ICU mortality of the experimental group was significantly lower than that of the control group ( < 0.05).The fluid intake in the stabilization and de-escalation phases was less than the the control group ( < 0.05). We divided these shock patients into survival group (92 cases) and non-survival (55 cases) according to whether they died in ICU, and the univariate analysis for ICU mortality showed that acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, SOFA score, Lac, hourly urine output, total fluid intake, fluid intake in the salvage and optimization stages, fluid intake in the stabilization and de-escalation stages were significantly different ( < 0.05) between survivers and non-survivers. Multivariete analysis showed that the fluid intake during the salvage and optimization phases, fluid intake in the stabilization and de-escalation phases were independent risk factors for ICU mortality.
Critical care ultrasound oriented shock fluid management could reduce fluid intake of stabilization and de-escalation phases, and improved adverse outcome; whether the fluid intake during stabilization and de-escalation phases, or the fluid intake during the salvage and optimization phases, both were associated with patient prognosis.
探讨以重症超声为导向的液体管理与休克患者预后之间的关系。
我们回顾性分析了四川大学华西医院重症医学科一项名为“以重症超声为导向的休克治疗（CCUSOST）”的随机对照试验数据。纳入以重症超声为导向治疗组（实验组）的77例患者和常规治疗组作为对照组的70例患者进行统计，以评估液体摄入量与预后之间的关系。采用单因素和多因素logistic回归分析来分析ICU死亡率的危险因素。
实验组和对照组患者的基线指标一致。实验组的ICU死亡率显著低于对照组（<0.05）。稳定期和降阶梯期的液体摄入量少于对照组（<0.05）。我们根据患者是否在ICU死亡将这些休克患者分为存活组（92例）和非存活组（55例），对ICU死亡率的单因素分析显示，急性生理与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、序贯器官衰竭评估（SOFA）评分、乳酸、每小时尿量、总液体摄入量、挽救与优化阶段的液体摄入量、稳定期和降阶梯期的液体摄入量在存活者和非存活者之间存在显著差异（<0.05）。多因素分析显示，挽救与优化阶段的液体摄入量、稳定期和降阶梯期的液体摄入量是ICU死亡率的独立危险因素。
以重症超声为导向的休克液体管理可减少稳定期和降阶梯期的液体摄入量，并改善不良结局；稳定期和降阶梯期的液体摄入量以及挽救与优化阶段的液体摄入量均与患者预后相关。
