亚临床心脏功能障碍可能会影响流体和血管压缩剂在败血性休克早期复苏期间的管理
Francesco Murgolo1, Rossella di Mussi1, Antonio Messina2
1Department of Precision-Regenerative Medicine and Jonic Area (DiMePRe-J), Section of Anesthesiology and Intensive Care Medicine, University of Bari "Aldo Moro", Bari, Italy.
Journal of anesthesia, analgesia and critical care
|August 28, 2023
概括
败血性休克患者的亚临床心脏功能障碍影响了早期的液体和血管压缩剂的使用. 建议早期对心脏进行临床评估,以获得更好的复苏策略.
科学领域:
- 关键护理医学 关键护理医学
- 心脏病学 心脏病学
- 血液动力学 血液动力学
背景情况:
- 败血性休克的早期复苏通常涉及流体和血管压缩剂,因诺特普被保留用于耐火性低输液.
- 败血性心脏功能障碍呈现出严重程度的范围,在初始复苏期间经常保持亚临床状态.
- 这项研究调查了亚临床心脏功能障碍是否影响早期败血性休克复苏时的液体和血管压缩剂管理.
研究的目的:
- 为了确定亚临床心脏功能障碍是否影响早期败血性休克复苏时的液体和血管压缩剂的使用.
- 为了评估亚临床心脏功能障碍和败血性休克患者的血液动力学参数之间的关联.
主要方法:
- 根据生存败血症运动 (SSC) 的指导方针复苏的败血症休克患者的前性收集数据的回顾性审查.
- 转肺热稀释 (TPTD) 用于在ICU入院时进行血液动力学监测.
- 亚临床心脏功能障碍被定义为TPTD衍生的心脏功能指数 (CFI) ≤4.5分钟-1.1.
主要成果:
- 42%的患者 (17/40) 呈现出亚临床心脏功能障碍 (CFI 3.6 ± 0.7 分钟-1).
- 患有亚临床功能障碍的患者接受了更多的液体 (57 ± 10毫升/公斤PBW) 和血管压缩剂 (诺拉上腺素0.65 ± 0.25毫克/公斤/分钟).
- 这些患者还表现出较低的心脏指数 (2.2 ± 0.6 L/min/m2) 和更高的全身血管阻力 (2721 ± 860 dynes*s*cm−5/m2).
结论:
- 亚临床心脏功能障碍在早期的败血性休克复苏中显著影响液体和血管压缩剂的使用.
- 这些发现支持在败血性休克管理中早期对心脏功能进行临床评估.
- 优化复苏策略可能受益于结合心脏功能评估.
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