| Objective: To investigate the role of ultrasound noninvasive cardiac output monitors in the rehydration treatment of diabetic ketoacidosis.Method: Through the randomized controlled study method,the patients with diabetic ketoacidosis admitted to the Emergency Medicine Department of the Affiliated Hospital of the Affiliated Hospital of Yangzhou University from June 2021 to February 2023 were collected as the research object,this study used independent sample mean comparison,calculated by PASS tool,with 72 h net intake as the core index,and calculate the sample size required for each group as 22 cases,due to the probability of sample loss,a certain sample size needs to be supplemented,and the samples included in the study were grouped into experimental and control groups using random number tables.The final results were 25 cases in the control group and the experimental group,for a total of 50cases;The control group monitored the patient’s vital signs through the vital signs monitor,and adjusted the amount and speed of rehydration in time.Experimental group: Use USCOM to monitor reasonably regulated fluid therapy before and after the PLR.PLR was implemented before USCOM monitoring: the head of the bed was raised by 45° to put the patient in a semi-recumbent position for 2 minutes before monitoring;The lower limb was then elevated by 45° so that the patient was in the supine position for 2 minutes before monitoring.Monitoring data was collected and stored in the equipment system.In this study,△SV≥10% was defined as liquid reactivity.When the monitoring parameters of △SV≥10% occur during fluid therapy monitoring,continued fluid replacement therapy is required.If △SV<10%,control the amount of rehydration or slow down the rehydration rate as much as possible according to actual clinical needs.Compared the net fluid inflow at 24,48 and 72 hours after admission,and the incidence of related clinical complications in the two groups,and compared the parameters of blood glucose at 24,48 and 72 hours after admission,the time of urinary ketone body conversion in the two groups,the days of hospitalization in the two groups,and USCOM at the end of rehydration therapy,and the SPSS tool was used for statistical analysis.Result: The differences in age,BMI(Body Mass Index),body temperature,systolic blood pressure,diastolic blood pressure,MAP(Mean Artery Pressure),respiratory rate,heart rate,Sp O2(Percutaneous Arterial Oxygen Saturation)and gender between the two groups were not statistically significant(P value > 0.05).There was no statistically significant difference between the clinical data of SV,MAP(Mean Artery Pressure),respiratory rate,heart rate,Sp O2(Percutaneous Arterial Oxygen Saturation)and gender(P value > 0.05).The difference between the two groups was statistically significant(P value < 0.001).The net fluid intake of patients in the experimental group was 2681.68±1833.34 ml,2934.12±1529.80 ml and 2916.36±1542.48 ml at the 24 th,48th and 72 nd hours after admission respectively.the net fluid intake of patients in the control group was 3351.00±1232.93 ml,4180.96±1833.93 ml and 4180.96±1833.93 ml at the 24 th,48th and 72 nd hours after admission respectively,The net fluid intake of patients in the experimental group was less than that of the control group at 24,48 and 72 hours after admission,with no statistically significant difference between groups in the net fluid intake at 24 hours(P value > 0.05)and a statistically significant difference between groups in the net fluid intake at 48 and72 hours(P value < 0.05).).The incidence of clinical complications in the control and experimental groups were hypoglycaemia(6 cases 24%;5 cases 20%),hypokalaemia(6cases 24%;5 cases 20%),hyperchloremic metabolic acidosis(4 cases 16%;3 cases 12%),acute renal failure(3 cases 12%;2 cases 8%),heart failure(5 cases 20%;3 cases 12%),cerebral oedema(1 case 4%;0 cases),pulmonary oedema(1 case 4%;0 cases),pleural effusion(2 cases 8%;1 case 4%),cardiac arrhythmia(5 cases 20%;3 cases 12%).In the experimental group,24,48 and 72 hour blood glucose was 16.07±3.70mmol/L,15.81±3.61mmol/L and 13.85±4.17mmol/L respectively.In the control group,24,48 and 72 hour blood glucose was 15.99±4.60mmol/L,14.84±4.23mmol/L and 13.32±3.30mmol/L respectively,Blood glucose decreased over time in both groups.The differences in blood glucose between the two groups at 24,48 and 72 h after admission were not statistically significant(P value > 0.05).The time to conversion of urinary ketone bodies was 6.04±2.34 days and 6.28±2.63 days for the patients in the experimental and control groups respectively.The time for urinary ketone bodies to turn negative was less in the experimental group than in the control group,and the difference between the two groups was not statistically significant(P value > 0.05).The number of days in hospital was 7.80±2.83 days and 6.04±2.34 days in the experimental group and the control group respectively.The number of days in hospital was less in the experimental group than in the control group,with a statistically significant difference between the two groups(P value = 0.036).Conclusion: USCOM monitoring and guidance of fluid replacement therapy for diabetic ketoacidosis patients can effectively reduce the net intake of fluids and effectively shorten the number of hospital stays,but it will not affect the rate of blood glucose drop,will not affect the time of urine ketone body turning negative,and can be used for clinical guidance of rehydration therapy in patients with diabetic ketoacidosis. |
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