RESUMEN
Objective:To investigate the application effects of non-invasive ultrasound cardiac output monitoring (USCOM) in fluid resuscitation guidance and hemodynamic evaluation of patients with sepsis.Methods:A total of 80 patients with sepsis who were treated in The Second Hospital of Jiaxing from January 2021 to December 2022 were included in this single-blind randomized controlled study. These patients were randomly divided into a control group ( n = 40) and an observation group ( n = 40). In the control group, continuous cardiac output indicated by pulse waveform monitoring was used to guide fluid resuscitation and monitor hemodynamic status, while in the observation group, USCOM was used to guide fluid resuscitation and monitor hemodynamic status. The fluid intake and outflow at 24, 48, and 72 hours after admission to the ICU were compared between the two groups. The changes in arterial blood lactate and oxygenation index at 1, 2, 3, 5, and 7 days after admission to the ICU were compared between the two groups. The time of admission to ICU, the length of ICU stay, and changes in hemodynamic indicators were compared between the two groups. The incidence of death within 28 days after admission to the ICU was compared between the two groups. Results:The liquid intake and output in the observation group at 24, 48 , and 72 hours after admission to the ICU were (4 178.13 ± 327.19) mL, (7 763.63 ± 324.08) mL, and (10 501.38 ± 376.74) mL, respectively, which were significantly lower than (4 527.35 ± 276.84) mL, (8 778.15 ± 361.42) mL, and (11 589.12 ± 413.27) mL in the control group ( t = 5.15, 13.22, 12.30, all P < 0.001). The arterial blood lactate levels in the observation group were significantly lower than those in the control group at 1, 2, 3, 5, and 7 days ( t = 5.73, 6.73, 9.98, 12.25, 14.47, all P < 0.001). There was no significant difference in oxygenation index between the two groups on the 1 st day ( P > 0.05). The oxygenation index in the observation group at 2, 3, 5 and 7 days was significantly higher than that in the control group ( t = -4.31, -8.19, -5.28, -9.44, all P < 0.05). The time of admission to ICU and the length of ICU stay in the observation group were (10.15 ± 2.43) days and (16.51 ± 1.36) days, respectively, which were significantly shorter than (12.75 ± 2.87) days and (17.68 ± 1.59) days in the control group ( t = 4.37, 3.54, both P < 0.05). After 24 hours of resuscitation, cardiac output, stroke output, and cardiac index in the observation group were (5.89 ± 0.51) L/min, (57.71 ± 3.82) mL, and (3.31 ± 0.35) L·min -1·m -2, respectively, which were significantly higher than (5.30 ± 0.37) L/min, (50.06 ± 3.25) mL, and (2.85 ± 0.34) L·min -1·m -2 in the control group ( t = -5.92, -9.65, -5.96, all P < 0.001). There was no significant difference in the 28-day mortality rate between the two groups ( P > 0.05). Conclusion:The guidance of USCOM on fluid resuscitation and hemodynamic status assessment in sepsis patients has an obvious effect, which can promote the improvement of patient oxygenation index, and shorten the time of admission to the ICU and the length of hospital stay.
