Effects of fluid resuscitation under pulse-indicated continuous cardiac output monitoring on endothelial function, inflammatory indexes and hemodynamics in patients with traumatic shock / 中国基层医药

ABSTRACT

Objective:To investigate the effects of fluid resuscitation under pulse-indicated continuous cardiac output monitoring on endothelial function, inflammatory indexes and hemodynamics in patients with traumatic shock.Methods:The clinical data of 62 patients with traumatic shock who received treatment in the First Affiliated Hospital of Zhejiang Chinese Medical University, China between July 2019 and July 2020 were retrospectively analyzed. These patients were divided into observation and control groups ( n = 31/group) according to different fluid resuscitation methods. The control group was given conventional fluid resuscitation and the observation group was subjected to guided fluid resuscitation under pulse-indicated continuous cardiac output monitoring. General treatment and nitric oxide, endothelin-1, C-reactive protein, interleukin-6, interleukin-1β, tumor necrosis factor-α, central venous pressure, mean arterial pressure, and central venous oxygen saturation before and 24 hours after treatment as well as complications were compared between the two groups. Results:Time to early resuscitation, duration of mechanical ventilation, intensive care unit length of stay and the length of hospital stay in the observation group were (5.33 ± 0.51) hours, (37.45 ± 4.84) hours, (8.75 ± 1.20) days, (16.85 ± 2.03) days, respectively, which were significantly shorter than those in the control group [(8.14 ± 1.20) hours, (46.06 ± 4.71) hours, (11.46 ± 1.63) days, (20.01 ± 2.41) days, t = 11.999, 7.098, 7.455, 5.584, all P < 0.01). At 24 hours after treatment, serum level of nitric oxide in the observation group was significantly higher than that in the control group [(52.04 ± 3.91) μmol/L vs. (40.25 ± 4.25) μmol/L, t = 11.367, P < 0.01]. Serum level of endothelin-1 in the observation group was significantly lower than that in the control group [(66.95 ± 4.75) ng/L vs. (78.04 ± 7.92) ng/L, t = 6.686, P < 0.01)]. Serum levels of C-reactive protein, interleukin-6, interleukin-1β, tumor necrosis factor-α in the observation group were (8.32 ± 1.56) mg/L, (113.03 ± 15.74) ng/L, (69.82 ± 6.50) ng/L, (42.80 ± 4.32) ng/L, respectively, which were significantly lower than those in the control group [(11.61 ± 1.74) mg/L, (130.42 ± 20.68) ng/L, (81.33 ± 7.30) ng/L, (56.11 ± 6.36) ng/L, t = 7.838, 3.726, 6.556, 9.639, all P < 0.01)]. Mean arterial pressure, central venous pressure and central venous oxygen saturation in the observation group were (76.64 ± 5.05) mmHg, (10.79 ± 0.53) mmHg, (79.93 ± 5.04) %, respectively, which were significantly higher than those in the control group [(70.32 ± 4.31) mmHg, (9.50 ± 0.62) mmHg, (73.40 ± 4.76) %, t = 5.300, 8.806, 5.245, all P < 0.01]. The incidence of complications in the observation group was significantly lower than that in the control group [9.68% (10/31) vs. 32.26% (8/31), χ2 = 4.769, P < 0.05]. Conclusion:Fluid resuscitation under pulse-indicated continuous cardiac output monitoring has an obvious effect traumatic shock, which can improve vascular endothelial function, inflammatory index and hemodynamic index, and is worthy of popularization and application.