| Objective:This study compared the microcirculation perfusion and hemodynamic parameters of patients with sepsis before and after treatment by comparing the effective fluid resuscitation in patients with sepsis guided by non-invasive hemodynamics detection system.Prognostic indicators to explore the significance of non-invasive hemodynamics detection system in fluid resuscitation in patients with sepsis Methods:During the Period from July 2017 to July 2018,a total of 60 Patients with sepsis and sepsis shock in the Department of Critical Care Medicine,Yan’an University Hospital were selected for various reasons.These Patients were assigned according to the random number table method.For the two groups,the observation group and the regular group were respectively 30 cases in each group,which were recorded as ICG group and CG group respectively.For all patients enrolled in the study,the criteria for fluid resuscitation refer to the recommendations and best practice statements in the 2016 Rescuing the Sepsis Campaign: International Guidelines for Sepsis and Sepsis Shock,and for organizations with low The perfusion was performed in the early stage of fluid resuscitation(completed within 6 hours),with an average arterial pressure of >65 mmHg,a lactate value of <4 mmol/L,and a central venous pressure of 8-12 mmHg.The initial infusion rate of the CG group was 10ml/kg/h,the resuscitation fluid was the sodium lactate balance solution,and the infusion rate of the tissue infusion for the first 3 hours was 30ml/kg/h.For patients with persistent hypotension,vasoactive drugs were added.Adrenalin and dobutamine);3 hours later,the infusion rate was adjusted according to the MBP,HR,RR and CVP displayed by the monitor.The ICG group used a non-invasive hemodynamics detection system(Production: Shenzhen Qianfan,model: CSM3000)to monitor cardiac function on the basis of conventional treatment,and liquid resuscitation according to the hemodynamic parameters it provided,adjusted according to SVV Infusion volume and infusion rate,according to the peripheral circulation index to guide the NE dose,according to CI adjustment dobutamine dose,appropriate use of diuretics(Furosemide 20 mg/time)for capacity overload.The changes in vital signs during fluid resuscitation were closely observed in both groups.Cardiopulmonary resuscitation was performed immediately for all patients with cardiac arrest caused by severe arrhythmia and heart failure during resuscitation.Observation index:General indicators: gender,age,BMI,etiologyMain indicators: APACHE II score,SOFA score,CVP,PH,Lac,6h lactate clearance,MBP,HR,RR,fluid volume,vasoactive drug use,hemodynamic ParametersSecondary indicators: in-hospital mortality,Post-recovery complications,ICU stay,28-day mortality Result:1.Comparison of general data between the two groups of patientsA total of 60 patients were included in the study.After statistical analysis,there were no significant differences in gender,age,BMI,infection type,APACHE II score and SOFA score between the two groups(P>0.05).2.Comparison of microcirculation and hemodynamic parameters between the two groups2.1 Before fluid resuscitation,there was no significant difference between CVP,PH,Lac,MBP,HR and RR in the observation group and the conventional group(P>0.05).2.2 After fluid resuscitation,CVP,PH,Lac,MBP,HR and RR in the observation group and the conventional group were significantly improved compared with those before resuscitation,and the difference was statistically significant(P<0.01).2.3 After fluid resuscitation,the PH and MBP of the observation group were significantly higher than that of the conventional group.CVP,Lac,HR and RR were significantly lower than the conventional group,and the difference was statistically significant(P<0.01).2.4 After fluid resuscitation,the 6h lactate clearance rate in the observation group was significantly higher than that in the conventional group,and the difference was statistically significant(P<0.01).2.5 The CO,CI,SV and SVV of the observation group were significantly improved after resuscitation,and the difference was statistically significant(P<0.01).3.Comparison of treatment Procedures between the two groups of patientsAfter resuscitation,the amount of infusion and norepinephrine in the observation group were lower than those in the conventional group,and the dose of dobutamine and urine were more than the conventional group,and the difference was statistically significant(P<0.01).4.Comparison of prognostic indicators between the two groups4.1 The average ICU stay in the observation group was less than that in the conventional group(7.41±1.58 VS.8.86±1.59),and the difference was statistically significant(P<0.01).4.2 The total complication rate in the observation group was significantly lower than that in the conventional group(19.23%VS.56.52%),and the incidence of heart failure in the observation group was significantly lower than that in the conventional group(0% VS.26.07%).The significance of learning(P<0.05),the incidence of other complications did not differ significantly(P>0.05).4.3 In-hospital mortality and 28-day mortality were significantly lower in the observation group than in the conventional group(13.33%VS.23.33%,26.67%VS.40.0%),but the difference was not statistically significant(P>0.05).4.4 There was no significant difference in the APACHE II score between the observation group and the conventional grouP(11.32±3.37 VS.11.78±5.07).The SOFA score of the observation group was lower than that of the conventional group(3.36±3.70 VS.5.43±4.47),with significant statistics.Learning differences(P <0.01).Conclusion:1.Early fluid resuscitation in patients with sepsis and sepsis shock can significantly reduce organ dysfunction.2.Liquid resuscitation under the guidance of the hemodynamic testing system can significantly improve the patient’s heart function,improve systemic perfusion,thereby reducing the in-hospital complications,shortening the hospital stay,and making the early fluid recovery of patients with sepsis shock more scientific and reasonable. |
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