Objective To investigate the impact of extended target-guided echocardiography (eFATE)protocol in ICU distributive shock patients. Methods A total of 118 patients were randomly divided into the study group(conventional program + eFATE)group and control group (conventional program group). The patients in both group were assessed by the routine methods. Those parameters such as heart rates(HR),mean arterial pressure (MAP), central venous pressure (CVP), cardiac output(CO), ejection fraction (EF),central venous oxygen saturation(ScvO2),APACHE Ⅱ score, lactic acid were measured every 6 hours in the first week,recorded the fluid intake volume at 6h,24h,72h and 1week. Additionally, in the study group,the patients assessed by ultrasound . The fluid intake volume , the goal-directed therapy(GDT)compliance rate,cardiomyopathy rate,ICU Check-in time,ICU mortality and 28-day mortality between the two groups were compared. Results The fluid intake volumes of 6 hours(P=0.027) and 24 hours liquid(P=0.018) in the study group were significantly lower than those in the control group. The GDT compliance rate of the study group was significantly higher than that in the control group(P=0.019),the ICU stay was significantly lower than that of the control group(P=0.005). The 28-day mortality was significantly lower in the study group than in the control group(P=0.039). Conclusion The extended target-guided echocardiographic scheme has significant positive effect on ICU distributive shock patient's capacity assessment,which can reduce the amount of fluid replacement during the clinical treatment, increase the GDT compliance rate and reduce the mortality.%目的 探讨扩展的目标导向超声心动图检查(eFATE)对ICU患者血容量评估的影响.方法 选取2014年12月至2016年12月宁夏人民医院重症医学科收治且发生分布性休克的患者.共入组118例,随机分为研究组(常规方案+eFATE方案组)和对照组(常规方案组).对照组使用ICU常规血流动力学方法监测及治疗,记录即刻、1周内每6h的心率、平均动脉压(MAP)、中心静脉压(CVP)、心排出量、射血分数(EF)、中心静脉血氧饱和度(ScvO2)、APACHE Ⅱ评分、乳酸;记录6、24、72h和1周的液体入量情况.研究组在常规评估手段时同时采用24h心脏超声评估流程.比较两组的液体用量、目标指导性治疗策略(goal-directed therapy, GDT)达标率、心肌抑制发生率、ICU入住时间、ICU病死率和28d病死率.结果 研究组6h液体用量(P=0.027)和24h液体用量(P=0.018)均少于对照组;研究组24h GDT达标率高于对照组(P=0.019);研究组ICU入住时间低于对照组(P=0.005);研究组28d病死率低于对照组(P=0.039).结论 eFATE方案对ICU分布性休克患者容量评估具有的积极意义,能降低临床治疗过程中补液量,增加GDT达标率,降低病死率.
展开▼
