Objective To study the effect of different fluid on early resuscitation of patients with septic shock by observing PiCCO and comparing hemodynamics,lactate clearance rate and mortality rate.Methods A total of 100 patients with septic shock were randomly divided into normal saline group(NS group),hydroxyethyl starch resuscitation group(HES group),4 ％ hypertonic saline resuscitation group(4％ NaCl group),hydroxyethyl starch 40 injection group(Holm group).Each group has 25 cases of patients.Changes of hemodynamic parameters,blood lactate clearance and mortality rate after treatment were monitored by PiCCO.Results Heart rate(HR) in four groups significantly reduced(P＜0.05).Central venous pressure(CVP),mean arterial pressure(MAP),cardiac output,intrathoracic blood volume index(ITBVI) significantly increased (P＜ 0.05).Extravascular lung water index in NS group increased significantly(P＜0.05).Liquid volume and the total recovery of liquid in 4 ％ NaCl group and Holm group were significantly less than those of NS group HES group(P＜0.01);Mean arterial blood pressure in Holm group significantly increased compared with the other three groups after recovery of 1 h(P＜0.01) ;Blood lactate clearance rate was higher than the other three groups in 24 h(P＜0.01) ;There were no difference in serious infection-related organ failure assessment(SOFA score),physiology and chronic health evaluation system Ⅱ (APACHE Ⅱ) score and 28 d mortality among four groups(P＞0.05).While the 28 d mortality rate in the Holm group showed a downward trend.Conclusion Four kinds of liquid can improve the hemodynamic state in the early fluid resuscitation in septic shock.Using Holm fluid can increases blood pressure rapidly and maintain the total volume in the less liquid.%目的 通过脉搏指示连续心输出量(PiCCO)系统观察比较不同液体进行早期液体复苏治疗对脓毒性休克患者血流动力学、血乳酸清除率和病死率的影响.方法 将100例脓毒性休克患者分为0.9％生理盐水复苏组(NS组)、羟乙基淀粉复苏组(HES组)、4％高渗盐水复苏组(4％NaC1组)、羟乙基淀粉40注射液组(霍姆液组),每组25例.以PiCCO系统监测各组治疗后血流动力学指标、血乳酸清除率和病死率的变化.结果 4组患者的心率(HR)显著减少,中心静脉压(CVP)、平均动脉压(MAP)、心输出量、胸腔内血容量指数(ITBVI)显著增加(P＜0.05).NS组的血管外肺水指数明显增加(P＜0.05).4％NaC1组、霍姆液组实验液体量及复苏液体总量均显著少于NS组和HES组(P＜0.01)；复苏1h,霍姆液组平均动脉压较其他3组明显升高(P＜0.01);24 h血乳酸清除率也较其他3组高(P＜o.01)；而4组间严重感染相关器官功能衰竭(SOFA)评分、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分和28 d病死率差异均无统计学意义(P＞0.05),但可观察到霍姆液组28 d病死率有下降趋势.结论 在脓毒性休克的早期液体复苏中,4种液体均可以改善血流动力学状态.使用霍姆液可在迅速提升血压的同时,保持较少的复苏液体总用量.
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