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超声心输出量监测仪在糖尿病酮症酸中毒补液治疗中的应用

Application of ultrasonic cardiac output monitor in rehydration therapy of diabetic ketoacidosis

    摘要
  • 摘要:
    目的 探讨超声心输出量监测仪(USCOM)在糖尿病酮症酸中毒(DKA)补液治疗过程中的作用。
    方法 选取50例DKA患者为研究对象，随机分为实验组和对照组，每组25例。对照组患者给予生命体征监护仪监测生命体征，并及时调整补液量和补液速度。实验组在被动抬腿试验(PLR)前后使用USCOM进行监测。以△每搏输出量(△SV)≥10%定义为有液体反应性，若△SV≥10%时，需要继续补液治疗，若△SV < 10%, 则根据实际临床需要尽可能控制补液量或减慢补液速度。比较实验组入院时及补液治疗结束时USCOM的相关参数; 比较2组入院24、48、72 h后的液体净入量和血糖; 比较2组患者相关临床并发症发生情况、尿酮体转阴时间以及住院时间。
    结果 2组患者一般临床资料比较，差异无统计学意义(P>0.05)。实验组患者经补液治疗后, SV与心输出量(CO)高于入院时，差异有统计学意义(P < 0.001)。实验组患者入院48、72 h后的液体净入量少于对照组，差异有统计学意义(P < 0.05或P < 0.001)。实验组不良事件发生总例数少于对照组。2组患者的血糖水平随时间延长而降低。实验组患者尿酮体转阴时间短于对照组，但差异无统计学意义(P>0.05)。实验组患者住院时间短于对照组，差异有统计学意义(P=0.036)。
    结论 USCOM可有效指导DKA患者的补液治疗，并实现优化液体管理，以及缩短住院时间，改善患者预后。

     

    Abstract:
    Objective To investigate the role of ultrasonic noninvasive cardiac output monitor(USCOM) in the treatment of diabetic ketoacidosis (DKA).
    Methods Fifty DKA patients were selected as the study objects and randomly divided into experimental group and control group, with 25 cases in each group. The control group was given vital signs monitor to monitor vital signs, and timely adjusted the amount and speed of fluid rehydration. The experimental group was monitored using USCOM before and after the passive leg raising (PLR). Liquid reactivity was defined as stroke output difference (△SV) ≥10%, if △SV was ≥10%, it was necessary to continue liquid replenishment treatment, if △SV was < 10%, according to the actual clinical it needed to control the amount of fluid replenishment or slow down the speed of fluid replenishment. The relevant parameters of USCOM were compared in the experimental group at admission and at the end of rehydration treatment; the net fluid intake and blood glucose were compared 24, 48 and 72 h after admission; the occurrence of related clinical complications, turning negative time of urine ketone body and the length of hospital stay were compared between the two groups.
    Results There was no significant difference in general clinical data between the two groups (P>0.05). The SV and cardiac output (CO) in the experimental group were significantly higher than those at admission after fluid rehydration (P < 0.001). The net fluid intake of the experimental group was significantly lower than that of the control group 48 and 72 h after admission (P < 0.05 or P < 0.001). The total number of adverse events in the experimental group was less than that in the control group. The blood glucose levels in the two groups decreased with time prolonging.The turning negative time of urine ketone body in experimental group was shorter than that in control group, but the difference was not statistically significant (P>0.05). The length of hospital stay in the experimental group was significantly shorter than that in the control group (P=0.036).
    Conclusion USCOM can effectively guide the rehydration therapy of DKA patients and achieve optimal fluid management, as well as shorten the length of hospital stay and improve patients' outcomes.

     

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