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论著·临床研究 | 更新时间:2023-12-05
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床旁重症超声在合并重度/极重度混合性通气功能障碍的非特发性脊柱侧凸患者中的应用效果
Application effect of bedside critical ultrasound in patients with non-idiopathic scoliosis and concomitant severe/extremely severe mixed ventilation dysfunction

广西医学 2023第45卷18期 页码:2184-2190

作者机构:刘威,硕士,住院医师,研究方向:外科重症。

基金信息:新疆维吾尔自治区卫生与健康适宜技术推广项目(SYTG-202172)

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  • 参考文献
目的 探讨床旁重症超声在合并重度/极重度混合性通气功能障碍的非特发性脊柱侧凸患者中的应用效果。方法 回顾性分析48例因非特发性脊柱侧凸行脊柱畸形矫正手术且术后入住ICU患者的临床资料。将ICU入住期间接受床旁重症超声干预的患者设为试验组(n=23),未接受床旁重症超声干预的患者设为对照组(n=25)。比较两组患者术后即刻、术后24 h、术后48 h、术后72 h的平均动脉压、血乳酸水平,术后第1个24 h、第2个24 h及第3个24 h的补液量,以及胸腔积液穿刺引流时间、机械通气时间、ICU住院时间及二次气管插管情况。结果 两组患者术后即刻、术后24 h、术后72 h的平均动脉压及术后各时间点的血乳酸水平差异无统计学意义(P>0.05);术后48 h试验组平均动脉压高于对照组(P<0.05)。试验组术后第1个24 h、第2个24 h及第3个24 h的补液量少于对照组(P<0.05)。试验组的胸腔积液穿刺引流时间、机械通气时间短于对照组(P<0.05)。试验组ICU住院时间短于对照组,二次气管插管发生率低于对照组,但差异无统计学意义(P>0.05)。结论 将床旁重症超声应用于合并重度/极重度混合性通气功能障碍的非特发性脊柱侧凸患者的术后管理,在不影响复苏效果的同时,可以减少术后补液量,缩短胸腔积液引流时间及机械通气时间,有助于改善患者预后。
ObjectiveTo explore the application effect of bedside critical ultrasound in patients with non-idiopathic scoliosis and concomitant severe/extremely severe mixed ventilation dysfunction. MethodsThe clinical data of 48 patients who underwent spinal deformity correction surgery because of non-idiopathic scoliosis and were admitted to ICU after surgery, were retrospectively analyzed. Patients receiving bedside critical ultrasound intervention during ICU stays were set as experiment group (n=23), while patients who did not receive bedside critical ultrasound intervention as control group (n=25). The mean arterial pressure and blood lactic acid level immediately, 24 hours, 48 hours, and 72 hours after surgery, and fluid replacement volume at the first 24 hours, second 24 hours, and third 24 hours after surgery, as well as puncture drainage time for pleural effusion, mechanical ventilation duration, length of ICU stay, and secondary tracheal intubation were compared between patients of the two groups. ResultsThere was no statistically significant difference in mean arterial pressure immediately, 24 hours, and 72 hours after surgery, and blood lactic acid level at various time points between the two groups (P>0.05). The experiment group exhibited a higher mean arterial pressure 48 hours after surgery as compared with the control group (P<0.05). The volumes of fluid replacement in the experiment group at the first 24 hours, second 24 hours, and third 24 hours after surgery were less than those in the control group (P<0.05). The puncture drainage time for pleural effusion, mechanical ventilation duration of the experiment group were shorter than those of the control group (P<0.05). The length of ICU stay in the experiment group was shorter than that in the control group, and incidence rate of secondary tracheal intubation was lower than that in the control group, but the difference was not statistically significant (P>0.05). ConclusionThe application of bedside critical ultrasound to postoperative management of patients with non-idiopathic scoliosis and concomitant severe/extremely severe mixed ventilation dysfunction can reduce postoperative fluid replacement volume, shorten puncture drainage time for pleural effusion and mechanical ventilation duration without affecting effect of resuscitation, which is helpful to ameliorate patients′ prognosis.

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