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目的评价症脓毒症患者液体复苏前后全身及肾脏灌注情况。方法选取在2013年6月至2016年6月入住本院并且被确诊为重症脓毒症患者70例,其中男性患者40例,女性患者30例;根据容量负荷试验(FC)获取的左室流出道速度时间积分(VTI%)来分组:容量反应性阳性组为VTI%≥12%,共36例患者;容量反应阴性组为VTI%<12%,共34例患者;在进行液体复苏之前进行一次多普勒超声的检测,分别得到肾血流量(RBF)、肾动脉阻力指数(RRI)的数值,在进行液体复苏之后6h重复进行超声检查,得到RBF、RRI的数值。结果在行液体复苏前后2组患者在年龄、Ramsay评分及呼气末正压通气(PEEP)方面差异无统计学意义(P>0.05),但是患者的体温差异有统计学意义(P<0.05);2组患者在行液体复苏前后液体平衡量方面差异无统计学意义(P>0.05);T0时在容量反应性阳性与容量反应性阴性2组患者之间RRI值相同;Lac在2组之间的差异无统计学意义(P>0.05);患者复苏后每搏输血量(SV)、心率(HR)、肌酐值(Cre)、中心静脉压(CVP)的数值同急性肾损伤(AKI)数值差异无统计学意义(P>0.05)。结论肾脏多普勒超声RRI数据可以识别早期AKI患者,肾脏多普勒超声RBF数据可以作为行液体复苏前后重症脓毒症患者全身及肾脏灌注的评价标准。
Objective To evaluate systemic and renal perfusion in patients with sepsis before and after fluid resuscitation. Methods Seventy patients admitted to our hospital from June 2013 to June 2016 were diagnosed as severe sepsis, including 40 male patients and 30 female patients. According to the volume load test (FC), left ventricular outflow (VTI%): 36 patients with VTI% ≥12% in volume-responsive positive group; 34 patients with VTI% <12% in volume-responsive negative group; performed prior to fluid resuscitation After a Doppler ultrasound examination, the values of renal blood flow (RBF) and renal artery resistance index (RRI) were respectively obtained. The values of RBF and RRI were obtained by repeating the ultrasound examination 6 hours after liquid resuscitation. Results There was no significant difference in age, Ramsay score and positive end-expiratory pressure (PEEP) between the two groups before and after liquid resuscitation (P> 0.05), but there was a significant difference in body temperature between the two groups (P <0.05) ; There was no significant difference between the two groups in the amount of fluid balance before and after liquid resuscitation (P> 0.05); the RRI was the same between the two groups of volume-responsive and volume-responsive patients at T0; (SV), heart rate (HR), creatinine (Cre) and central venous pressure (CVP) were the same as those of acute kidney injury (AKI) No significant difference between the values (P> 0.05). Conclusions Renal Doppler ultrasound RRI data can be used to identify patients with early stage AKI. Renal Doppler echocardiography (RBF) data can be used to evaluate systemic and renal perfusion in patients with severe sepsis before and after liquid resuscitation.