血动力学不稳定和全身静脉拥堵患者的液体挑战引起的门脉动指数的变化:前性队列研究
Martin Ruste1,2,3, Rehane Reskot4, Rémi Schweizer4,5
1Service d'anesthésie-réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, 59, Boulevard Pinel, 69394, Lyon Cedex, Bron, France. martin.ruste@chu-lyon.fr.
Annals of intensive care
|November 1, 2024
概括
在患有静脉堵塞的危急病患者中,不管液体的反应如何,在不改善输液的情况下,液体的施用会使静脉堵塞恶化. 这突显了这种患者群体中流体挑战的潜在风险.
科学领域:
- 关键护理医学 关键护理医学
- 心血管生理学心血管生理学
- 血液动力学 血液动力学
背景情况:
- 关于在患有全身静脉堵塞和血液动力学不稳定的患者中注射液体的益处存在不确定性.
- 评估液体反应对于指导重症患者治疗至关重要.
研究的目的:
- 研究流体挑战对严重病患者全身静脉堵塞和外周 perfusion 的影响.
- 分析流体响应如何影响这些变化.
主要方法:
- 一个单中心前性队列研究,涉及36名危急病患者,血液动力学不稳定性和中心静脉压升高 (最大静脉腔直径≥20毫米).
- 液体挑战 (4毫升/千克乳酸林格) 评估了心脏指数,中心静脉压力,超声波静脉拥堵参数 (门静脉流动脉动性指数,VExUS得分) 和外周 perfusion (毛细血管补充时间,外周 perfusion 指数) 的变化.
- 流体反应者 (心脏指数增加> 10%) 与不反应者之间的比较.
主要成果:
- 液体挑战增加了门脉动指数,VExUS得分和总体队列中的中央静脉压.
- 这些拥堵参数的增加在流体反应者和不反应者之间是相似的.
- 没有观察到外周 perfusion 参数的显著改善.
结论:
- 在患有血液动力学不稳定和静脉堵塞的患者中,服用液体会加剧静脉堵塞.
- 不管液体反应状态如何,静脉拥堵的恶化都会发生.
- 在这种患者群体中,液体的使用并不能改善外周 perfusion.
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