A case report with discussion and exploration on a critical point in fluid resuscitation in septic shock patients

doi:10.3877/cma.j.issn.2096-1537.2018.02.020

Abstract

Abstract:

Objective

To explore a critical point in fluid resuscitation in septic shock patients, based on dynamic change of vital signs, lab results, clinical examinations when invasive monitoring was lacking.

Methods

The data of patients′ vital signs were analyzed retrospectively, and a critical point in fluid resuscitation based on hemodynamic parameters, tissue oxygenation, multiple organ function and radiographic results was explored.

Results

There was a significant correlation between fluid resuscitation capacity and vital signs in patients with septic shock. A critical point in fluid resuscitation could be found by analyzing vital signs combined with hemodynamic parameters and tissue oxygenation.

Conclusion

A critical point in fluid resuscitation can be helpful in fluid resuscitation in patients with septic shock, although further investigation is necessary.

Key words: Septic shock, Fluid resuscitation, Hemodynamics

Zhenhong Qi, Mingyuan Ma, Menghua Deng, Haobo Jiang, Liqun Tang. A case report with discussion and exploration on a critical point in fluid resuscitation in septic shock patients[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2018, 04(02): 211-214.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2018.02.020

https://icu.cma-cmc.com.cn/EN/Y2018/V04/I02/211

Figures/Tables 3

References 11

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系统评估	序号	观察指标	阳性结果
生命体征动态变化	1	心率	平均心率较前1个小时增快超过10次/min
?	2	血压	平均血压较前1个小时下降超过10 mmHg
?	3	氧饱和度	在镇静剂量及呼吸机参数不变的前提下，氧饱和度较前1个小时下降超过3%
?	4	尿量	出现少尿或无尿，经补液后尿量无增加
?	5	出入量	累计出入量总平衡超过体重的7%，或70 ml/kg
实时实验室检查	6	血乳酸值	血乳酸值不随着补液量增加而下降，反而上升或维持在偏高水平（>5 mmol/L）
?	7	心功能	B型钠尿肽前体超过正常值，并较上一次检查值升高3倍以上
?	8	肾功能	血肌酐较正常值上升超过50%
实时影像学检查	9	实时胸片	心影或肺门较转入时增大，胸片上肺实变影超过4个肺野，且不能用积液、肺不张或结节来解释^[10]
体格检查	10	心肺检查	心率显著增快，心脏浊音区较前增大；双肺啰音增多，气道内分泌物显著增加
?	11	肢端水肿	肢端新发浮肿
被动抬腿试验	12	?	被动抬腿试验阴性

系统评估	序号	观察指标	阳性结果
生命体征动态变化	1	心率	平均心率较前1个小时增快超过10次/min
?	2	血压	平均血压较前1个小时下降超过10 mmHg
?	3	氧饱和度	在镇静剂量及呼吸机参数不变的前提下，氧饱和度较前1个小时下降超过3%
?	4	尿量	出现少尿或无尿，经补液后尿量无增加
?	5	出入量	累计出入量总平衡超过体重的7%，或70 ml/kg
实时实验室检查	6	血乳酸值	血乳酸值不随着补液量增加而下降，反而上升或维持在偏高水平（>5 mmol/L）
?	7	心功能	B型钠尿肽前体超过正常值，并较上一次检查值升高3倍以上
?	8	肾功能	血肌酐较正常值上升超过50%
实时影像学检查	9	实时胸片	心影或肺门较转入时增大，胸片上肺实变影超过4个肺野，且不能用积液、肺不张或结节来解释^[10]
体格检查	10	心肺检查	心率显著增快，心脏浊音区较前增大；双肺啰音增多，气道内分泌物显著增加
?	11	肢端水肿	肢端新发浮肿
被动抬腿试验	12	?	被动抬腿试验阴性

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