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目的:探讨液体负平衡对感染性休克合并急性肺损伤(ALI)患者早期复苏及预后的影响。方法:将2010年1月~2014年9月我院急诊外科收治的84例感染性休克合并ALI的患者随机分为治疗组和对照组,每组各42例患者。治疗组采用出入量负平衡方式进行液体管理,对照组采用出入量平衡方式进行液体管理。观察和比较两组治疗前后氧合指数(PaO_2/FiO_2)、中心静脉压(CVP)、平均动脉压(MAP)、心指数(CI)、血管外肺水指数(ELWI)及APACHEⅡ评分的变化,记录和比较两组的机械通气时间、ICU住院时间、多器官功能障碍综合征(MODS)的发生率及28 d的病死率。结果:入院后3d、7d,治疗组的MAP较对照组明显降低,ELWI、PaO_2/FiO_2则明显升高(P<0.05);治疗前、治疗后6h,两组的APACHEⅡ评分比较均无显著性差异(P>0.05),而治疗组治疗后24h、48h的APACHEⅡ评分较对照组则明显降低(P<0.05);与对照组比较,治疗组的机械通气时间、ICU住院时间显著缩短,MODS发生率明显降低(P<0.05)。结论:在维持循环稳定和保证器官灌注的前提下,液体负平衡有助于减轻感染性休克合并ALI患者的心肺损伤,促进患者早期复苏,改善患者的预后。
Objective: To investigate the effect of fluid negative balance on early resuscitation and prognosis in patients with septic shock and acute lung injury (ALI). Methods: From January 2010 to September 2014, 84 patients with septic shock complicated with ALI admitted to our department of emergency surgery were randomly divided into treatment group and control group, with 42 patients in each group. The treatment group used a negative balance of intake and output for liquid management, and the control group used liquid intake and output balance for liquid management. The changes of PaO2 / FiO2, CVP, MAP, CI, ELWI and APACHE II scores before and after treatment were observed and compared. The mechanical ventilation time, ICU length of stay, incidence of multiple organ dysfunction syndrome (MODS) and mortality at 28 days were recorded and compared between the two groups. Results: On the 3rd and 7th day after admission, the MAP in the treatment group was significantly lower than that in the control group, and the levels of ELWI and PaO_2 / FiO_2 were significantly increased (P <0.05). There was no significant difference in APACHEⅡ scores between the two groups before treatment and 6h (P> 0.05), while the APACHEⅡscore of the treatment group was significantly lower than that of the control group at 24h and 48h after treatment (P <0.05). Compared with the control group, the mechanical ventilation time, ICU hospitalization time and the incidence of MODS in the treatment group were significantly shorter The rate was significantly lower (P <0.05). CONCLUSION: Under the premise of maintaining circulatory stability and ensuring organ perfusion, fluid negative balance can help reduce the cardiopulmonary injury in patients with septic shock and ALI, promote early recovery and improve prognosis of patients.