内科

目的探讨早期目标导向液体复苏治疗脓毒症伴呼吸衰竭患者的效果。方法回顾性分析106例脓毒症伴呼吸衰竭患者的临床资料，依据治疗方法将患者分为对照组和研究组，每组53例。对照组患者接受常规液体复苏，研究组患者接受早期目标导向液体复苏。比较两组患者复苏前和复苏后6 h的生命体征指标［心率、呼吸频率、心排血指数（CI）、中心静脉压（CVP）、平均动脉压（MAP）］、动脉血血气分析指标［氧合指数（PaO2/FiO2）、动脉血二氧化碳分压（PaCO2）、动脉血氧饱和度（SaO2）］、动脉血乳酸水平，以及复苏前和复苏后24 h血浆黏附分子指标［P选择素、细胞黏附分子-1（CAM-1）］、序贯器官功能衰竭（SOFA）评分、急性生理学与慢性健康状况（APACHE Ⅱ）评分；对比两组患者机械通气时间、28 d病死率，以及复苏结束24 h后不良反应发生情况。结果复苏后6 h，研究组心率、呼吸频率、动脉血PaCO2水平、动脉血乳酸水平均低于对照组，CI、CVP、MAP、动脉血PaO2/FiO2、动脉血SaO2均高于对照组（均P＜0.05）。复苏后24 h，研究组血浆P选择素水平、血浆CAM-1水平、SOFA评分、APACHE Ⅱ评分均低于对照组（均P＜0.05）。研究组机械通气时间短于对照组（P＜0.05），但两组28 d病死率和复苏结束24 h后不良反应总发生率差异均无统计学意义（均P＞0.05）。结论早期目标导向液体复苏可有效地稳定脓毒症伴呼吸衰竭患者生命体征，降低心输出量，改善动脉血气，缩短机械通气时间，安全性高。

ObjectiveTo observe the effect of early goal-directed fluid resuscitation in patients with sepsis and respiratory failure. MethodsThe clinical data of 106 patients with sepsis and respiratory failure were retrospectively analyzed. The patients were divided into a control group or an experimental group according to their treatment, with 53 patients in each group. Patients in the control group received routine fluid resuscitation, and patients in the experimental group received early goal-directed fluid resuscitation. The vital signs indexes (heart rate, respiratory frequency, cardiac output index ［CI］, central venous pressure ［CVP］, mean arterial pressure ［MAP］), arterial blood gas analysis indexes (oxygenation index arterial partial pressure of oxygen ［PaO2］/fraction of inspired oxygen［FiO2］, arterial partial pressure of carbon dioxide ［PaCO2］, arterial oxygen saturation ［SaO2］), arterial blood lactate level before and 6 hours after the resuscitation; plasma adhesion molecular indexes ［P-selectin, cell adhesion molecule-1(CAM-1)］, Sequential Organ Failure Assessment (SOFA) scores, and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores before and 24 hours after the resuscitation, the duration of mechanical ventilation, the 28-day fatality rate, and the occurrence of adverse reactions 24 hours after the end of resuscitation were compared between the two groups. ResultsAfter 6 hours of resuscitation, heart rate, respiratory frequency, PaCO2 level, and arterial blood lactate level in the experimental group were lower than those in the control group, and CI, CVP, MAP, PaO2/FiO2, and SaO2 in the experimental group were higher than those in the control group (all P＜0.05). After 24 hours of resuscitation, the plasma P-selectin level, plasma CAM-1 level, SOFA score, and APACHE II score in the experimental group were lower than those in the control group (all P＜0.05). The duration of mechanical ventilation in the experimental group was shorter than that in the control group (P＜0.05), but there was no statistically significant difference in the 28-day fatality rate or the total incidence of adverse reactions 24 hours after the end of resuscitation between the two groups (all P＞0.05). ConclusionEarly goal-directed fluid resuscitation can effectively stabilize the vital signs of patients with sepsis and respiratory failure, reduce cardiac output, improve arterial blood gas, shorten the duration of mechanical ventilation, and have high safety.