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Sihlole ukubaluleka kokuqapha okuguquguqukayo kwe-ultrasound eseceleni kombhede we-vena cava diameter engaphansi (IVCD) kanye nokuwa kokuhogela (inferior vena cava collapse index [IVCCI]) ekulawuleni ukuphelelwa amanzi emzimbeni ezigulini ekwelapheni okuhlanganisiwe kwe-renal (CRRT).Ukuhluleka kwenhliziyo kanye nokwehluleka kwenhliziyo okunamandla.Ingqikithi yeziguli ezingama-90 ezinokwehluleka kwezinso kanye nenhliziyo ebuhlungu zikhethiwe ezithole i-CRRT egunjini labagula kakhulu (ICU) kusukela ngoJanuwari 2019 kuya kuJuni 2021. Ngokwezindlela ezahlukahlukene zokuhlola umthamo wegazi, iziguli zahlukaniswa ngokungahleliwe zaba yiqembu le-ultrasound, iqembu lesipiliyoni. kanye neqembu lokulawula.Siqhathanise amazinga e-serum creatinine, i-potassium, kanye nobuchopho be-N-terminal natriuretic peptide (NT-proBNP), isikhathi sokuthuthukisa izimpawu zokuhluleka kwenhliziyo, isikhathi se-CRRT, ukusetshenziswa kwe-ventilator, ubude be-ICU yokuhlala, ukusetshenziswa kwe-vasopressor, nokugula kweqembu.izehlakalo ezingafuneki. Kwakungekho mehluko obalulekile ku-serum creatinine, i-potassium, namazinga e-NT-proBNP ekuqhathaniseni ngokubili phakathi kwamaqembu ngaphambi nangemuva kwe-CRRT (P> 0.05). Kwakungekho mehluko obalulekile ku-serum creatinine, i-potassium, namazinga e-NT-proBNP ekuqhathaniseni ngokubili phakathi kwamaqembu ngaphambi nangemuva kwe-CRRT (P> 0.05). Не было никаких существенных различий в уровнях креатинина в сыворотке, калия kanye ne-NT-proBNP при попарных сравнениях между гропппа, Ты парных сравнениях между гропппа, Т0ми (5) Kwakungekho mehluko obalulekile ku-serum creatinine, i-potassium, namazinga e-NT-proBNP ekuqhathaniseni ngokubili phakathi kwamaqembu ngaphambi nangemuva kwe-CRRT (P> 0.05). CRRT前后各组血清肌酐、血钾、NT-proBNP水平比较差异无统计学意义（P>0.05）. CRRT前后各组血清肌酐、血钾、NT-proBNP水平比较差异无统计学意义（P>0.05）. Не было существенной разницы в уровнях сывороточного креатинина, сывороточного калия и NT-proBNP между группами до и после ПЗПТ (P>0,0). Awukho umehluko obalulekile ku-serum creatinine, i-serum potassium, namazinga e-NT-proBNP phakathi kwamaqembu angaphambi nangemuva kwe-CRRT (P>0.05).Isikhathi sokuthuthukiswa kwezimpawu zokuhluleka kwenhliziyo, isikhathi se-CRRT, nokuhlala kwe-ICU kwakungaphansi kwe-ultrasound kanye namaqembu esipiliyoni kuneqembu lokulawula; umehluko wawubalulekile ngokwezibalo (P <0.05). umehluko wawubalulekile ngokwezibalo (P <0.05). различия были статистически значимыми (P < 0,05). umehluko wawubalulekile ngokwezibalo (P <0.05).差异有统计学意义 (P <0.05)差异有统计学意义 (P <0.05) Разница была статистически значимой (P <0,05). Umehluko ububalulekile ngokwezibalo (P<0.05). Ubude besikhathi sokusebenzisa i-Ventilator babuphansi ku-ultrasound kanye namaqembu esipiliyoni uma kuqhathaniswa neqembu lokulawula, kunomehluko obalulekile ngokwezibalo phakathi kwe-ultrasound namaqembu okulawula (P <0.05). Ubude besikhathi sokusebenzisa i-Ventilator babuphansi ku-ultrasound kanye namaqembu esipiliyoni uma kuqhathaniswa neqembu lokulawula, kunomehluko obalulekile ngokwezibalo phakathi kwe-ultrasound namaqembu okulawula (P <0.05). Продолжительность использования ИВЛ была ниже в группах УЗИ и опыта по сравнению с контрольной группой со статигипах 5, УЗИ & опыта по сравнению с контрольной группой со статигипах знаж0, УЗИ. Ubude besikhathi sokusetshenziswa kwe-ventilator besiphansi ku-ultrasound kanye namaqembu esipiliyoni uma kuqhathaniswa neqembu lokulawula, kunomehluko obalulekile ngokwezibalo phakathi kwe-ultrasound namaqembu okulawula (P<0.05).超声组和体验组呼吸机使用时间低于对照组，超声组与对照组比较差异有统计孉 。＂有统计孉 P <0.05). Время использования ИВЛ в группе УЗИ и опытной группе было меньше, чем в контрольной группе, а разница между группой УЗИ и контрольной группой была статистически значимой (P < 0,05). Isikhathi sokusetshenziswa kwe-ventilator eqenjini lase-US kanye neqembu lokuhlola besimfushane kuneqembu elilawulayo, futhi umehluko phakathi kweqembu lase-US neqembu lokulawula ububaluleke ngokwezibalo (P <0.05).Isikhathi sokusetshenziswa kwe-vasopressors kokubili kweqembu le-ultrasound kanye neqembu lokulawula lalingaphansi kweqembu lokuhlola; umehluko wawubalulekile ngokwezibalo (P <0.05). umehluko wawubalulekile ngokwezibalo (P <0.05). Разница была статистически значимой (P <0,05). Umehluko ububalulekile ngokwezibalo (P<0.05).差异有统计学意义 (P <0.05)差异有统计学意义 (P <0.05) Разница была статистически значимой (P <0,05). Umehluko ububalulekile ngokwezibalo (P<0.05).Iqembu le-ultrasound libe nezigameko eziphansi zezenzakalo ezimbi uma kuqhathaniswa namaqembu okuhlola nokulawula; umehluko wawubalulekile ngokwezibalo (P <0.05). umehluko wawubalulekile ngokwezibalo (P <0.05). Разница была статистически значимой (P <0,05). Umehluko ububalulekile ngokwezibalo (P<0.05).差异有统计学意义 (P <0.05)差异有统计学意义 (P <0.05) Разница была статистически значимой (P <0,05). Umehluko ububalulekile ngokwezibalo (P<0.05).Ukuqapha okuguquguqukayo kwe-Ultrasound kwe-EFA kanye nokuwa kwekhala kungahlola ngokunembile isimo somthamo wegazi futhi kunikeze izincomo zokulungisa ukuphelelwa amanzi emzimbeni ku-CRRT kanye nokukhulula ngokushesha izimpawu zokuhluleka kwenhliziyo ezigulini ezine-renal and acute heart failure.
Ukwehluleka kwezinso okuhambisana nesifo senhliziyo esibuhlungu kuyisifo esibucayi esibonakala ngokukhula ngokushesha kwesifo, ukuhlala isikhathi eside esibhedlela kanye nokufa okuphezulu, okusongela kakhulu ukuphepha kwesiguli.Emisebenzini yomtholampilo, isu lokwelapha eliyinhloko ukukhululeka kwezimpawu zokuhluleka kwenhliziyo, okuhlanganisa i-cardiotonic, i-diuretic ne-vasodilators.Kodwa-ke, ngenxa yokungasebenzi kahle kwezinso, ama-metabolites aqoqiwe kanye nevolumu yegazi kulezi ziguli azikwazi ukukhishwa ngezinso.Umfutho wegazi ophezulu kanye nokuminyana kuvame ukusabela kabi kuma-diuretics avamile kanye nama-vasodilators kuphela, kuyilapho ukwelashwa okuqhubekayo kwe-renal replacement (CRRT) kungalungisa ukulimala kwezinso ngokusebenzisa i-cardiopulmonary blood clearance, ukususwa okuqhubekayo kwama-metabolites kanye nomthamo wegazi eliningi emzimbeni, ngaleyo ndlela kunciphise ukwehluleka kwenhliziyo ngaphambi kokuhlinzwa kanye ne-postoperative.ukuvivinya umzimba okuthuthukisa ngempumelelo izimpawu kanye nesimo esijwayelekile seziguli ezinesifo senhliziyo3.
Kodwa-ke, ukusetshenziswa komtholampilo kwe-CRRT ngokuvamile kubangela izinkinga ezihlukahlukene, enye yazo eyinhloko i-arterial hypotension4,5.Ucwaningo luye lwabonisa ukuthi izinga lokunciphisa umthamo wegazi liyimbangela ebalulekile yoshintsho kumfutho wegazi ngesikhathi se-CRRT.Ukuphelelwa amanzi ngokweqile nokushesha kudlula ukubuya koketshezi lwe-interstitial okuholela ku-hypovolemia esebenzayo kanye ne-hypotension6.Ukuhlola kahle isimo somthamo wegazi lesiguli ngesikhathi se-CRRT kanye nokuklama uhlobo olufanele lokuphelelwa amanzi emzimbeni kuyinselele odokotela ababhekene nayo.
Eminyakeni yamuva nje, ukuqapha kwe-ultrasound ye-inferior vena cava (SVC) ububanzi kanye nokuhlukahluka kwayo (i-NSAID kanye nokuwa kwephunga, inkomba ye-vena cava collapse ephansi [IVVC]) isetshenziswe ngenxa yezinzuzo zayo ezinembile, ezinembile, ezingahlaseli, neziphindaphindayo.Ucwaningo lwangaphambilini luphakamise ukusebenzisa i-IVCD njengesilinganiso sokuhlola isimo somthamo wegazi ezigulini7,8,9 kodwa kunemibiko embalwa yokusetshenziswa kwe-CRRT ezigulini ezinokuhluleka kwezinso eziyinkimbinkimbi ngenxa yokwehluleka kwenhliziyo okunamandla.Ngakho-ke, sasihlose ukuphenya ukusetshenziswa komtholampilo kokuqapha okunamandla kombhede kwama-NSAID nama-NSAID ukulungisa ukuphelelwa amanzi emzimbeni ngesikhathi se-CRRT ezigulini ezinokwehluleka kwezinso okuba nzima ukuhluleka kwenhliziyo okubuhlungu.
Lolu cwaningo lwamukele umklamo olawulwa ngokungahleliwe futhi lwagunyazwa yi-Biomedical Research Ethics Committee yaseNanchang University Second Affiliated Hospital.Ucwaningo lwenziwe ngokuhambisana neziqondiso nemithethonqubo efanele.Zonke iziguli zaziswe ngezinzuzo ezingaba khona kanye nezingozi.Zonke iziguli zithole imvume ebhaliwe enolwazi.
Sikhethe iziguli ezingama-90 ezinokwehluleka kwezinso ezihlanganiswe nesifo senhliziyo esibuhlungu esidinga i-CRRT engeniswe egunjini labagula kakhulu (ICU) esibhedlela sethu kusukela ngoJanuwari 2019 kuya kuJuni 2021. Iminyaka yobudala yabahlanganyeli yayingu-68.23±11.Iminyaka engu-41, abesifazane abangama-28 namadoda angama-62.
Sifake iziguli ezilandelayo: (1) ubudala ≥18 iminyaka kanye ≤80 iminyaka;(2) kuvunyelwene ne-CRRT;(3) ngokuhambisana "neziqondiso zokuqala zokuxilongwa nokwelashwa kokuhluleka kwenhliziyo okunamandla ngemiphumela ethuthukisiwe jikelele yesifo sezinso (2019)" Izindlela zokuxilonga zokuhluleka kwenhliziyo.
Asizifaki iziguli ezinanoma yikuphi kwalokhu okulandelayo: (1) umlando wokugula noma ukugula kwengqondo;(2) umlando wesifo senhliziyo sokuzalwa, i-hypertrophic cardiomyopathy, noma umfutho wegazi ophakeme wamaphaphu;(3) umsebenzi wokujiyisa okhubazekile phakathi nezinyanga ezi-3 zokugcina.ukopha kwe-visceral noma kwamathumbu noma ukuphikisana ne-heparin anticoagulant therapy;(4) Isikhathi se-CRRT ≤ amahora angu-12;(5) I-Ultrasound ayikwazi ukubona i-vena cava engaphansi, okuholela ekulahlekeni kwedatha;(6) ukushaqeka kwe-cardiogenic noma ingxenye ye-cardiac ejection ≤ 50%.
Iziguli zahlukaniswa ngokungahleliwe zaba amaqembu amathathu (i-ultrasound, ukuhlola nokulawula) kusetshenziswa ithebula lezinombolo ezingahleliwe.Iqembu ngalinye lalihlanganisa iziguli ezingu-30.Kwakungekho mehluko obalulekile ngokwezibalo phakathi kwamaqembu amathathu obulili, ubudala, isimo somzimba esibucayi, kanye nesilinganiso sesifo esingelapheki II, nezici zabahlanganyeli zaziqhathaniswa phakathi kwamaqembu ekuqaleni (Ithebula 1).
Ukuqala i-CRRT, odokotela balalisa isiguli emhlane baveze isifuba nesisu saso.Indawo ukusuka ku-IVCD kuya kunqubo ye-xiphoid yabe isikalwa kusetshenziswa i-3.5 MHz yohlu lwe-convex probe yensimbi ephathwa ngesandla ye-Doppler ultrasound yombala we-Mindray M7.Imijikelezo yokuphefumula eminingi yarekhodwa kusetshenziswa i-M-mode ultrasound ebangeni elingu-2.0 cm ukusuka enhliziyweni efanele eduze kwe-vena cava engaphansi.Ubukhulu bedayamitha yokuphefumula kokuphela (IVCDmax) kanye nobubanzi obuncane bokuphelelwa yisikhathi (IVCDmin) kukalwe ngesikhathi esisodwa.I-IVCD ichazwa ngokuthi IVCDmax futhi IVCCI ibalwa kusetshenziswa ifomula elandelayo: (IVCDmax-IVCDmin)/IVCDmax×100%.Zonke izivivinyo zenziwa ithimba lochwepheshe be-ultrasound, elihlanganisa odokotela abaneziqu ze-ultrasound.Bonke odokotela bathola ukuqeqeshwa okufanayo kokulawula ikhwalithi ukuze kuqinisekiswe ukuqoqwa okuphelele kwedatha ye-ultrasound. Ngokusekelwe ku-IVCD elinganiswa udokotela oyinhloko we-ultrasound njengenani leqiniso elivamile, ukuhlaziywa kwangaphambili kokuhlolwa kubonise iphutha elihlobene nezilinganiso ze-IVCD ngodokotela abahlukene be-<0.05 kanye nephutha elihlobene lezilinganiso ze-IVCD ngudokotela ofanayo ngezikhathi ezahlukene ze-IVCD. < 0.02. Ngokusekelwe ku-IVCD elinganiswa udokotela oyinhloko we-ultrasound njengenani leqiniso elivamile, ukuhlaziywa kwangaphambili kokuhlolwa kubonise iphutha elihlobene nezilinganiso ze-IVCD ngodokotela abahlukene be-<0.05 kanye nephutha elihlobene lezilinganiso ze-IVCD ngudokotela ofanayo ngezikhathi ezahlukene ze-IVCD. < 0.02. На основании измеренного главным врачом УЗИ МЖК как условно истинного значения, предэкспериментальный анализ показал относительную погрешность измерения МЖК разными врачами < 0,05 и относительную погрешность измерения МЖК одним и тем же врачом в разные периоды времени < 0,02. Ngokusekelwe ku-MFA elinganiswa udokotela we-ultrasound oyinhloko njengenani langempela elinemibandela, ukuhlaziywa kwangaphambili kokuhlola kubonise iphutha elihlobene ekulinganiseni i-MFA ngodokotela abahlukene <0.05 kanye nephutha elihlobene nokulinganisa i-MFA ngodokotela ofanayo ngezikhathi ezahlukene <0.02 .以 超声 主任 医师 测量测量 IVCD 为 常规 真值 真值 分析前以 超声 主任 医师医师 Принимая за условную истинную величину МЖК, измеренную главным врачом УЗИ, предэкспериментальный анализ показал, что относительная погрешность измерения МЖК разными врачами составляет <0,05, а относительная погрешность измерения МЖК одним и тем же врачом в разные периоды времени был <0,02. Ukuthatha njengenani langempela elinemibandela le-MFA elikalwa udokotela we-ultrasound oyinhloko, ukuhlaziywa kwangaphambili kokuhlola kubonise ukuthi iphutha elihlobene lokulinganisa i-MFA ngodokotela abahlukene ngu-<0.05, kanye nephutha elihlobene lokulinganisa i-MFA ngudokotela ofanayo izikhathi ezihlukene zazingu-<0.02.Isikhathi sokulinganisa sendlela ngayinye ye-ultrasonic cishe imizuzu eyi-10 kuya kweyi-15.Inkomba ngayinye ikalwe izikhathi ezi-3 futhi inani elimaphakathi labalwa.Odokotela balungise ukuphelelwa amanzi emzimbeni ngokwe-IVCD ne-IVCCI ngokuphinda inqubo engenhla njalo emahoreni angu-4 kuze kube yilapho i-CRRT iyekwa.
Isimo somthamo wegazi sihlolwe ngokuvumelana neziqondiso ezisebenzayo ze-British Society of Echocardiography10: IVCD ≤ 2.1 cm nge-IVCCI> 50%, echazwe njengesimo sevolumu ephansi; Isimo somthamo wegazi sihlolwe ngokuvumelana neziqondiso ezisebenzayo ze-British Society of Echocardiography10: IVCD ≤ 2.1 cm nge-IVCCI> 50%, echazwe njengesimo sevolumu ephansi; I-Статус объема крови оценивался в соответствии с практическими рекомендациями Isimo somthamo wegazi sihlolwe ngokuvumelana nezincomo zomkhuba we-British Society of Echocardiography10: IVCD ≤ 2.1 cm ne-IVCCI> 50%, echazwe njengesimo esiphansi sevolumu;根据英国超声心动图学会的实用指南评估血容量状态10：IVCD ≤ 2.1 cm 且IVCCI > 50%，定义，定义。 Ngokusho komhlahlandlela osebenzayo we-United Kingdom ultrasonography society's assessment of blood volume status10: IVCD ≤ 2.1 cm 且IVCCI> 50%, echazwa njengesimo sevolumu ephansi; Оценка объема крови в соответствии с практическими рекомендациями Британского общества эхокардиографиии10: IVCD ≤ 2,1 спомендациями 5 Ukuhlolwa komthamo wegazi ngokwezincomo ezisebenzayo ze-British Society of Echocardiography10: I-IVCD ≤ 2.1 cm kanye ne-IVCCI> 50%, echazwe njengesimo se-hypovolemic; I-IVCD ≤ 2.1 cm ne-IVCCI <50% noma i-IVCD> 2.1 cm ne-IVCCI> 50%, echazwe njengesimo sevolumu esilinganiselwe; I-IVCD ≤ 2.1 cm ne-IVCCI <50% noma i-IVCD> 2.1 cm ne-IVCCI> 50%, echazwe njengesimo sevolumu esilinganiselwe; I-IVCD ≤ 2,1 см при IVCCI < 50% или IVCD > 2,1 см при IVCCI > 50%, что определяется как состояние сбалансированного объема; I-IVCD ≤ 2.1 cm ne-IVCCI <50% noma i-IVCD > 2.1 cm ne-IVCCI > 50%, echazwa njengesimo sokulinganisela kwevolumu; IVCD ≤ 2.1 cm 且IVCCI < 50% 或IVCD > 2.1 cm 且IVCCI > 50%，定义为平衡容积状态； I-IVCD ≤ 2.1 cm 且IVCCI <50% noma IVCD > 2.1 cm 且IVCCI > 50%, echazwe njengesimo sevolumu esilinganiselwe; I-IVCD ≤ 2,1 см и IVCCI <50% или IVCD> 2,1 см и IVCCI> 50%, определяемые как состояние равновесного объема; I-IVCD ≤ 2.1 cm kanye ne-IVCCI <50% noma IVCD > 2.1 cm kanye ne-IVCCI > 50%, echazwe njengesimo somthamo wokulinganisa; kanye ne-IVCD > 2.1 cm ene-IVCCI <50%, echazwa njengesimo sevolumu ephezulu. kanye ne-IVCD > 2.1 cm ene-IVCCI <50%, echazwa njengesimo sevolumu ephezulu. kanye ne-IVCD > 2,1 см с IVCCI < 50%, что определяется как состояние большого объема. kanye ne-IVCD > 2.1 cm ene-IVCCI <50%, echazwa njengesimo sevolumu ephezulu.和IVCD > 2.1 cm 且IVCCI < 50%，定义为高容量状态。和IVCD > 2.1 cm 且IVCCI <50%, echazwa njengesimo somthamo ophezulu. kanye ne-IVCD > 2,1 см и IVCCI < 50%, что определяется как состояние большого объема. kanye ne-IVCD > 2.1 cm kanye ne-IVCCI <50%, echazwa njengesimo esikhulu sevolumu.I-Diuresis yansuku zonke yabantu abanempilo ingu-1500-2000 ml.Ukuze kube lula ukubala, i-diuresis evamile yansuku zonke ichazwa ngokuthi yi-1800 ml, ne-diuresis ephakathi kwama-300 ml njalo emahoreni ama-4.Ukuhlolwa kwangaphambilini kwangaphambili kubonise ukuthi uma umthamo wokuphelelwa amanzi emzimbeni udlula umthamo ovamile womchamo izikhathi ezingu-4 phakathi namahora angu-4 esimweni somthamo ophezulu, imvamisa yezinkinga ikhula kakhulu;uma idlula umthamo ojwayelekile womchamo izikhathi ezi-2, isikhathi sokuthuthukiswa kwezimpawu zokuhluleka kwenhliziyo kanye nemvamisa yezinkinga ziye zanda kakhulu.Ezimweni zebhalansi yevolumu, imvamisa yezinkinga yanda kakhulu lapho umthamo wokuphelelwa amanzi emzimbeni udlula izikhathi ezi-2 umthamo ojwayelekile womchamo phakathi namahora ama-4, futhi isikhathi sokuthuthukisa izimpawu zokuhluleka kwenhliziyo sanda kakhulu lapho umthamo wokuphelelwa amanzi emzimbeni ufana ne umthamo ojwayelekile womchamo..Umthamo ohlosiwe wokuphelelwa amanzi emzimbeni phakathi namahora ama-4 wabekwa ezingeni lika-1000 ml ezigulini ezine-hypervolemia kanye ne-500 ml ezigulini ezinomthamo wegazi olinganiselayo.Ngenxa yokuthi ukuphelelwa amanzi emzimbeni okuqhubekayo esimweni se-hypovolemic kungaholela ku-hypotension, futhi i-hydration iba yimbi kakhulu izimpawu zokuhluleka kwenhliziyo, odokotela balungisa i-4-hour dehydration target ku-0 mL yeziguli ze-hypovolemic (CRRT 4-hour dehydration = 4-hour dehydration target + 4- ngehora ukwamukela - i-diuresis yamahora angu-4).
Odokotela balungiselwe ukuphelelwa amanzi emzimbeni besebenzisa isikali esivamile sokuqina esisekelwe ekushayeni kwenhliziyo, umfutho wegazi omaphakathi, umfutho we-venous omaphakathi, nama-pulmonary rales ngemva kwe-CRRT (Ithebula 2).
Ukuhlolwa kwenziwa njalo emahoreni angu-4 kusukela ekuqaleni kwe-CRRT kuze kube yilapho isiguli sisizwa ukuthi sehle kudivayisi.Udokotela ulungise umgomo wokuphelelwa amanzi emzimbeni wamahora angu-4 waba ngu-1000 ml, 500 ml no-0 ml futhi wathola u-8-11, 4-7 no-0-3 (NRRT emahoreni angu-4 = amahora angu-4 okuhlosiwe) Umthamo + amahora angu-4 - umchamo wamahora angu-4 okukhiphayo).
Kusukela ekuqalisweni kwe-CRRT kuya ekunqanyulweni kwezidakamizwa, umgomo wokuphelelwa amandla kwamanzi wawuhlala njalo ku-100 ml / h futhi akukho mthamo owahlolwa ngesikhathi sokwelashwa (ukuphelelwa amandla kwe-CRRT ngamahora angu-4 = ukuphelelwa amandla kwamanzi okuhlosiwe emahoreni angu-4 + ukungena emahoreni angu-4).h) h – diuresis 4 h).
Ngaphezu kwalezi zinyathelo zokuhlola ezihlosiwe ezingenhla zokulungisa ukuphelelwa amanzi emzimbeni, womathathu amaqembu eziguli athola ukwelashwa okufanayo, okuhlanganisa nokwelashwa kwesifo esiwumsuka, uhlelo lokulwa namagciwane, ukuphathwa komzila womoya, isu lokungena komoya ngomshini, ukugcinwa kwevolumu yoketshezi kanye nebhalansi ye-electrolyte (4.0 mmol) ) /l < potassium < 5.3 mmol/l), ukwelashwa kwezidakamizwa, i-colloidal liquid supplementation efana ne-albumin (ukugcina amazinga e-albhamuin> 3.5 g/l), nokwesekwa kokudla okunomsoco.
Womathathu amaqembu eziguli aphathwe ngesihlanzi segazi esifanayo (uhlelo lwePrismaFlex) kanye nohlelo olufanayo lwe-CRRT (uhlelo lwe-CVVHD).Zonke iziguli zithole i-extracorporeal heparin ye-anticoagulation yendawo kanye ne-protamine neutralization.Odokotela balungisa imithamo ye-heparin ne-protamine ngokusekelwe ezimisweni ezine zokujiyisa kwegazi (isikhathi se-thromboplastin esicushiwe sigcinwa phakathi nezikhathi eziyi-1-1.5 ezijwayelekile).Ku-CPT, ukugeleza kwegazi kugcinwa ku-150-200 ml/min futhi ukugeleza kwe-dialysate kugcinwa ku-2000 ml/h (ukwakheka kwe-dialysate: saline 2000 ml; umthamo womjovo oyinyumba 1000 ml; 50% isixazululo 10 ml; 10% saline, 20 ml; magnesium sulfate, 2.5 ml; 10% potassium chloride, 7.5 ml; sodium bicarbonate, 45 ml; peripheral calcium chloride, 10 ml ngehora).
Lapho isiguli siba ne-hypotension, yeka ukuphelelwa amanzi emzimbeni ngokushesha futhi unikeze uketshezi olufakwa emthanjeni kanye nama-vasopressors (okuhlanganisa i-norepinephrine ne-dopamine) njengoba kudingeka ukuze kugcinwe isilinganiso somfutho wegazi wesiguli sibe ngaphezu kuka-65 mmHg.
Amazinga e-serum creatinine, i-potassium, kanye ne-N-terminal pro-brain natriuretic peptide (NT-proBNP) alinganiswa amahora angu-24 ngaphambi nangemva kwe-CRRT.Isikhathi sokuthuthukisa ukuhluleka kwenhliziyo, isikhathi se-CRRT, isikhathi sokusetshenziswa kwe-ventilator, isikhathi sokuhlala esikhungweni sokunakekelwa okuphuthumayo, isikhathi sokusetshenziswa kwe-vasopressor, namazinga ezenzakalo ezimbi (kuhlanganise ne-hypotension, arrhythmias, ne-delirium kodwa hhayi isigqi esiyingozi) zaqoqwa ngesikhathi sokulaliswa esibhedlela.) idatha.I-Intensive Care Unit.Ukuvama kwezehlakalo ezimbi kubalwe ngokusekelwe ekutheni izehlakalo ezimbi zenzeka yini ezigulini ezibhalisiwe.
Ukuthuthukiswa kwezimpawu: Ngokusho kwe-New York Classification of Heart Function, ukuqina kwesifuba kanye ne-dyspnea kuthuthukisiwe kwaze kwaba yi-grade 1, futhi imvamisa ye-expectoration yesikhwehlela esinegwebu e-pink yehle ngo-20% uma kuqhathaniswa nokuhlolwa kwangaphambilini (ngaphandle kweziguli ezine-endotracheal intubation), izimpawu. zazibhekwa njengezithuthukisiwe.
Ukuqapha okuthuthukisiwe: ukuncipha kwenhliziyo ngama-20%, izinga lokuphefumula, ukucindezela kwe-venous emaphakathi, noma umfutho we-arterial omaphakathi.
Odokotela benza ukuhlola kwamahora onke, futhi lapho iziguli zihlangabezana nazo zonke lezi zindlela ezintathu ezingenhla, ukuhluleka kwenhliziyo yazo kubhekwa njengokuthuthukisiwe.
Ukuhlaziywa kwezibalo kwenziwa kusetshenziswa isofthiwe ye-SPSS 22.0 (IBM Corp., Armonk, NY, USA).Idatha eqhubekayo ichazwa njengencazelo ± ukuchezuka okujwayelekile.Idatha yesigaba ichazwa njengamafrikhwensi namaphesenti.Umehluko phakathi kwamaqembu amabili uhlolwe kusetshenziswa i-t-test Yomfundi yokuhlukahluka okuqhubekayo noma ukuhlolwa kwe-chi-square kokuhluka kwezigaba. Ukubaluleka kwezibalo kwamiswa ku-P <0.05. Ukubaluleka kwezibalo kwamiswa ku-P <0.05. Статистическая значимость была установлена ​​​​на уровне P <0,05. Ukubaluleka kwezibalo kusethwe ku-P<0.05.统计学显着性设定为P <0.05.统计学显着性设定为P <0.05. Статистическая значимость была установлена ​​​​на уровне P <0,05. Ukubaluleka kwezibalo kusethwe ku-P<0.05.
Amazinga e-serum creatinine, potassium, kanye ne-NT-proBNP emaqenjini amathathu ehle phakathi namahora angu-24 we-CRRT. Umehluko phakathi kwamaqembu wawubalulekile ngokwezibalo (P <0.05), nakuba kwakungekho umehluko ophawulekayo obonwe ekuqhathaniseni okubili phakathi kwamaqembu amathathu (P> 0.05) (Ithebula 3). Umehluko phakathi kwamaqembu wawubalulekile ngokwezibalo (P <0.05), nakuba kwakungekho umehluko ophawulekayo obonwe ekuqhathaniseni okubili phakathi kwamaqembu amathathu (P> 0.05) (Ithebula 3). Различия внутри групп были статистически значимыми (P < 0,05), хотя при попарном сравнении между тремя групппами не наблуппами не наблуппами не наблуппами не наблуппами не наблуппами не наблуппами не наблуппами не наблуппами не наблуппами не наблуппами  Umehluko phakathi kwamaqembu ububalulekile ngokwezibalo (P <0.05), nakuba ungekho umehluko obalulekile phakathi kwamaqembu amathathu uma kuqhathaniswa ngokubili (P > 0.05) (Ithebula 3).组内差异具有统计学意义（P <0.05），但三组之间的成对比较无显着差异（P>0）））））组内差异具有统计学意义（P <0.05），但三组之间的成对比较无显着差异（P>0））））） I-Различия внутри групп были статистически значимыми (P <0,05), но попарные сравнения между тремя группами суественно не 00,05 (3,5)> (3) Umehluko phakathi kwamaqembu ububalulekile ngokwezibalo (P <0.05), kodwa ukuqhathanisa ngokubili phakathi kwamaqembu amathathu bekungehluke kakhulu (P > 0.05) (Ithebula 3).Ukuze ubone ngeso lengqondo kangcono izinguquko zevolumu, siphinde sahlela izinguquko ku-NT-proBNP, IVCD, kanye ne-IVCCI (Izibalo 1 kanye no-2).
I-Dynamics of the mean values ​​​​IVKD ne-IVKKI ye-CPT yokuqala eqenjini le-ultrasound leziguli ezingama-30 ngemuva kokungeniswa e-ICU.
Isikhathi sokuthuthukisa ukuhluleka kwenhliziyo, isikhathi se-CRRT, nokuhlala kwe-ICU kwakuphansi kakhulu ku-ultrasound kanye neqembu lesipiliyoni kuneqembu lokulawula. Umehluko wawubalulekile ngokwezibalo (P <0.05), kanti kwakungekho umehluko omkhulu ezinkomba ezingenhla phakathi kwe-ultrasound kanye namaqembu esipiliyoni (P> 0.05) (Fig. 3). Umehluko wawubalulekile ngokwezibalo (P <0.05), kanti kwakungekho umehluko omkhulu ezinkomba ezingenhla phakathi kwe-ultrasound kanye namaqembu esipiliyoni (P> 0.05) (Fig. 3). Различия были статистически значимыми (Р < 0,05), тогда как достоверных различий по вышеуказаным показателям между групИпами 0,05 (30) Umehluko wawubalulekile ngokwezibalo (P <0.05), kuyilapho kwakungekho umehluko ophawulekayo kumingcele engenhla phakathi kwe-ultrasound kanye namaqembu esipiliyoni (P> 0.05) (Fig. 3).差异有统计学意义（P <0.05），而超声组与体验组在上述指标上差异无统计学意伉 .） 3P3P差异有统计学意义（P <0.05），而超声组与体验组在上述指标上差异无统计学意5P乛ﾉ（0 Разница была статистически значимой (Р < 0,05), но достоверной разницы между группой УЗИ и группой опыта по вышеуказанны, 5 (3, 5). Umehluko wawubalulekile ngokwezibalo (P <0.05), kodwa kwakungekho umehluko omkhulu phakathi kweqembu le-ultrasound kanye neqembu lokuhlola ngokwemigomo engenhla (P> 0.05) (Fig. 3).
Isikhathi sokusetshenziswa kwe-ALV kokubili eqenjini le-ultrasound naseqenjini lokuhlola sasiphansi kuneqembu lokulawula. Umehluko phakathi kwe-ultrasound namaqembu okulawula wawubalulekile ngokwezibalo (P <0.05), kuyilapho kungekho mehluko obalulekile owabonwa phakathi kwamaqembu okuhlangenwe nakho nokulawula, noma phakathi kokuhlangenwe nakho namaqembu e-ultrasound (P> 0.05). Umehluko phakathi kwe-ultrasound namaqembu okulawula wawubalulekile ngokwezibalo (P <0.05), kuyilapho kungekho mehluko obalulekile owabonwa phakathi kwamaqembu okuhlangenwe nakho nokulawula, noma phakathi kokuhlangenwe nakho namaqembu e-ultrasound (P> 0.05). Разница между ультразвуковой и контрольной группами была статистически значимой (P < 0,05), тогда как между опытной и контрольной группами, а также между опытной и ультразвуковой группами не наблюдалось существенной разницы (P > 0,05). Umehluko phakathi kwamaqembu e-ultrasound kanye namaqembu okulawula wawubalulekile ngokwezibalo (P <0.05), kuyilapho kwakungekho umehluko omkhulu phakathi kwamaqembu okwelapha nokulawula naphakathi kwamaqembu okwelapha kanye ne-ultrasound (P> 0.05).超声组 与 对照组 差异 有 统计学 意义 (p <0.05), 而而经验组经验组), 而而 与与 对照组对照组超声组 与 对照组 差异 有 意义 (p <0.05) 而 经验组 与 对照组或 与经验组 超声组 超声组无 超声组无 Разница между группой УЗИ и контрольной группой была статистически значимой (P < 0,05), но не было существенной разницы между группой опыта и группой контроля или между группой опыта и группой УЗИ (P> 0,05). Umehluko phakathi kweqembu le-ultrasound neqembu lokulawula lalibalulekile ngokwezibalo (P <0.05), kodwa kwakungekho umehluko ophawulekayo phakathi kweqembu locwaningo neqembu lokulawula noma phakathi kweqembu locwaningo neqembu le-ultrasound (P > 0.05).
Isikhathi sokusetshenziswa kwe-vasopressor e-US namaqembu okulawula sasifushane kuneqembu lokwelapha futhi umehluko wawubalulekile ngokwezibalo (P <0.05), kuyilapho kwakungekho umehluko omkhulu phakathi kwe-US namaqembu okulawula (P> 0.05).) (Ithebula 4).
Izehlakalo ezimbi zenzeke ezigulini ezi-5 kwezingu-30 eqenjini le-ultrasound (5 ene-hypotension, 1 ene-arrhythmia), ezigulini eziyi-16 kwezingu-29 eziseqenjini lesipiliyoni (eziyi-16 ezine-hypotension, ezi-4 ezine-arrhythmia no-1 ene-delirium), naseqenjini elilawulayo. : eqenjini kwakukhona amacala angu-16 kwangu-29 (amacala angu-7 we-hypotension, amacala angu-8 we-arrhythmia, amacala angu-6 we-delirium). Izehlakalo zezenzakalo ezimbi eqenjini le-ultrasound zaziphansi kakhulu kunalokho ekuhlangenwe nakho namaqembu okulawula, futhi umehluko wawubalulekile ngokwezibalo (P <0.05). Izehlakalo zezenzakalo ezimbi eqenjini le-ultrasound zaziphansi kakhulu kunalokho ekuhlangenwe nakho namaqembu okulawula, futhi umehluko wawubalulekile ngokwezibalo (P <0.05). I-Частота нежелательных явлений в группе УЗИ была значительно ниже, чем в опытной и контрольной группах, и разница значительно 5,00 (5). Izigameko zezenzakalo ezimbi eqenjini le-ultrasound zaziphansi kakhulu kunamaqembu okuhlola nokulawula, futhi umehluko wawubalulekile ngokwezibalo (P <0.05).超声组不良事件发生率明显低于体验组和对照组，差异有统计学意义（P<0.05）. P <0.05. I-Частота нежелательных явлений в группе УЗИ была значительно ниже, чем в группе опыта и контрольной группе, разителько, разитель, и разительного Izigameko zezenzakalo ezimbi eqenjini le-ultrasound zaziphansi kakhulu kunamaqembu okuhlola nokulawula, futhi umehluko wawubalulekile ngokwezibalo (P <0.05). Ngokuphambene, umehluko phakathi kokuhlangenwe nakho namaqembu okulawula ubungabalulekile ngokwezibalo (P > 0.05) (Ithebula 5). Ngokuphambene, umehluko phakathi kokuhlangenwe nakho namaqembu okulawula ubungabalulekile ngokwezibalo (P > 0.05) (Ithebula 5). Напротив, разница между опытной и контрольной группами не была статистически значимой (P > 0,05) (табл. 5). Ngokuphambene nalokho, umehluko phakathi kwamaqembu okuhlola nokulawula ubungabalulekile ngokwezibalo (P> 0.05) (Ithebula 5).相反，经验组和对照组之间的差异无统计学意义（P > 0.05）（表5）.相反，经验组和对照组之间的差异无统计学意义（P > 0.05）（表5）. Напротив, разница между опытной группой и контрольной группой не была статистически значимой (P > 0,05) (таблица 5). Ngokuphambene nalokho, umehluko phakathi kweqembu lokuhlola neqembu lokulawula wawungabalulekile ngokwezibalo (P> 0.05) (Ithebula 5).
Ukuhluleka kwezinso kuhlangene nokuhluleka kwenhliziyo okubuhlungu kuhilela izinqubo eziyinkimbinkimbi ze-pathophysiological.Ama-metabolites noketshezi okweqile emzimbeni akukwazi ukukhishwa izinso ezilimele.Ukunqwabelana kwama-metabolites noketshezi lomzimba kungakhuphula umthwalo wenhliziyo futhi kuholele nasekuhlulekeni kwenhliziyo okubuhlungu11.
Ukusebenzelana phakathi kokwehluleka kwezinso nokuhluleka kwenhliziyo kuyakhula, kwakha umbuthano ononya ogcina uholela ekuwohlokeni okubukhali kokusebenza kwenhliziyo nezinso, okusongela kakhulu ukuphepha kwesiguli12.Izinso zikhipha uketshezi oluningi kanye nama-metabolite emzimbeni ukuze kuthuthukiswe isimo sesiguli13.Kodwa-ke, indlela engcono kakhulu yokuthola ukukhululeka okusheshayo nokuphephile kwezimpawu zokuhluleka kwenhliziyo ihlala ingacacile.Ngakho-ke, kubaluleke kakhulu ukuhlola kahle isimo sevolumu yegazi lesiguli ukuze kube lula ukulungiswa kokuphelelwa amanzi emzimbeni kwe-CRRT.
Njengamanje, izindlela eziyinhloko zokuhlola umthamo wegazi zihlanganisa ukusetshenziswa kwe-catheter ye-pulmonary artery, ukuhlolwa kwe-pulse (okubonisa ukuphuma kwenhliziyo okuqhubekayo), i-transesophageal echocardiography, kanye ne-bioimpedance14,15,16,17.Lezi zindlela zinezinzuzo, kodwa futhi zinemikhawulo eminingi.Odokotela abaningi basakhetha ukusebenzisa izindlela ezivamile zokuhlola umthamo wegazi lesiguli, njengokuhlola isisindo esomile sesiguli, ukuhlola ukutholakala kwama-pulmonary rales noma i-edema emaphethelweni aphansi nasebusweni, nokuhlola izinguquko zezimpawu ezibalulekile.Nakuba lezi zindlela zilula futhi kulula ukuzisebenzisa, ukwethembeka kwazo kuphansi futhi azikwazi ukuhlangabezana nezidingo zokuhlolwa komtholampilo okusheshayo, okuguquguqukayo, okunembile nokungahlaseli.
Lolu cwaningo lusebenzise izindlela ze-ultrasound nezindlela zokuhlola ukukala umthamo wegazi ezigulini eziku-ultrasound kanye namaqembu esipiliyoni, futhi kuqhathaniswe imiphumela neqembu lokulawula.Sithole ukuthi amazinga e-serum creatinine, i-potassium, ne-NT-proBNP ehla emaqenjini amathathu phakathi namahora angu-24 we-CRRT, futhi kwakungekho umehluko ophawulekayo phakathi kwamaqembu amathathu, okubonisa ukuthi izindlela zokuhlola umthamo wegazi ezahlukene azizange zithinte ukusebenza kahle kwe-serum.Ukususwa kwe-creatinine ne-potassium ngesikhathi sokwelashwa kokuqala.Awukho umthelela obalulekile kumazinga we-NT-proBNP obonwe.
Siphinde sathola ukuthi isikhathi sokuthuthukisa ukuhluleka kwenhliziyo, isikhathi se-CRRT, nokuhlala kwe-ICU kwakumfushane kakhulu ku-ultrasound namaqembu okuhlola kuneqembu lokulawula.Uma kuqhathaniswa neqembu lokulawula, isikhathi sokusebenzisa i-ventilator eqenjini le-ultrasound sancishiswa kakhulu, futhi umehluko wawubalulekile ngokwezibalo.Le miphumela iphakamisa ukuthi i-ultrasound neqembu lokwelapha lithole ukuthuthukiswa okusheshayo kwezimpawu ze-HF, isikhathi esifushane se-CRRT, nokuhlala kwe-ICU uma kuqhathaniswa neqembu lokulawula ngaphandle kokuhlolwa kwevolumu yoketshezi.
Ucwaningo lwethu luphakamisa ukuthi ukuhlolwa okufika ngesikhathi kwevolumu ye-ambulatory fluid ngesikhathi se-CRRT kunenani elikhulu lomtholampilo ekulawuleni ukuphelelwa amandla kwamanzi ezigulini ezinenkinga yokuhluleka kwezinso kanye nokuhluleka kwenhliziyo okunamandla.
Lapho siqhathanisa ukusetshenziswa kwama-vasopressors kanye nezigameko zezenzakalo ezimbi (isb, hypotension, arrhythmia, delirium), sithole ukuthi isikhathi sokusetshenziswa kwe-vasopressor sasifushane kakhulu e-US kanye namaqembu okulawula kunaseqenjini lokwelapha, kanye nesigameko esibi. Izenzakalo eqenjini lase-US zaziphansi kakhulu (i-hypotension, i-arrhythmia, i-delirium) iphansi kakhulu kunamaqembu okuhlola nokulawula.
Sicabangele izizathu ezimbalwa zale miphumela.Okokuqala, izindlela ezisetshenziswayo zinenani elithile ekuhloleni iziguli zevolumu ephezulu, njengokuthuthuka okusheshayo kwezimpawu zokuhluleka kwenhliziyo, isikhathi se-CRRT, nokuhlala kwe-ICU, kuyilapho ukunemba kwazo kungatshazwa ezigulini ezintula umthamo.ube nokukhuphuka okuguquguqukayo kwesilinganiso senhliziyo nomfutho wegazi, ongazibonakalisa njengesimo se-pseudo-hypervolemic ngokumelene nesizinda se-CRRT, okuholela ekuphelelweni kwamanzi ngokushesha, okwandisa imvamisa ye-hypotension kanye nobude besikhathi sokusetshenziswa kwe-vasopressor.Okwesibili, iziguli eziseqenjini lokulawula zancipha kancane futhi ngokulinganayo.Nakuba ukusetshenziswa kwe-vasopressors kufushane, izimpawu zokuhluleka kwenhliziyo zixazulula kancane, isikhathi se-CRRT sanda kakhulu, ukuhlala kwe-ICU kudonsa isikhathi eside, futhi izigameko zezenzakalo ezimbi ezifana ne-arrhythmia ne-delirium zanda.Okwesithathu, iziguli kula maqembu amathathu zahlala kumshini wokuphefumula isikhathi eside kakhulu kunezimpawu zokuhluleka kwenhliziyo ezithuthukisiwe, okungenzeka ngenxa yokuthuthukiswa kwamazinga komoyampilo ezigulini ngemuva komshini wokuphefumula.Ngaphezu kwalokho, nakuba umthamo wegazi lesiguli wawusaminyene, izimpawu zokuhluleka kwenhliziyo zaba ngcono kakhulu.Uma i-ventilator imisiwe, izimpawu zokuhluleka kwenhliziyo zingase zibuye.Ngakho-ke, isikhathi sokungena komoya ngomshini kufanele sandiswe ukuze kuqinisekiswe ukuthi izimpawu zesiguli zokuhluleka kwenhliziyo aziphindi.
Ngokuphambene, izimpawu zokuhluleka kwenhliziyo zaba ngcono ngokushesha eqenjini le-ultrasound, ngesikhathi esifushane kakhulu se-CRRT, ukuhlala kwe-ICU, kanye nokusetshenziswa kwe-ventilator.Okubaluleke nakakhulu, izehlakalo ze-hypotension ehlobene ne-CRRT, ubude besikhathi sokusetshenziswa kwe-vasopressor, kanye nezenzakalo ezimbi zancishiswa kakhulu.
Umkhawulo oyinhloko wocwaningo lwethu ukuthi bekuwucwaningo lwesikhungo esisodwa esinosayizi omncane wesampula.Ngakho-ke, ucwaningo oluzoba yizikhungo eziningi ezinosayizi omkhulu wesampula luyadingeka ukuze kuqinisekiswe lokho esikutholile futhi kunikeze odokotela isisekelo esingcono.
Sengiphetha, ngenxa yokukhula ngokushesha kokwehluleka kwezinso okuhambisana nokuhluleka kwenhliziyo okubuhlungu, ukulinganisa umthamo wegazi kufanele kube okunembile futhi okunembile.Ukuqapha okuguquguqukayo kwe-Ultrasound kwama-NSAID nama-NSAID kunganikeza izincomo ezinembile zokulungiswa kokuphelelwa amanzi kwe-CRRT ezigulini ezinokuhluleka kwezinso okuyinkimbinkimbi ukuhluleka kwenhliziyo okubuhlungu.Ingakhulula ngokushesha izimpawu zokwehluleka kwenhliziyo, inciphise izehlakalo zemiphumela emibi kanye nezindleko zokwelashwa egunjini labagula kakhulu, futhi ithuthukise izinga lempilo yeziguli.Ngakho-ke, ukuqapha okunamandla kwe-LPVC ne-NPVC kunezinzuzo ezinhle zezenhlalo nezomnotho.
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