关键词: 肺疾病, 慢性阻塞性；休克；速度时间积分；全心舒张末期容积指数；液体治疗；治疗结果

Abstract: Background　Central venous pressure（CVP） provides little value for guiding fluid therapy for septic shock in chronic obstructive pulmonary disease（COPD） patients as they often have right heart insufficiency. The widespread application of ultrasound in the ICU has made bed-side measurement of left ventricular outflow tract velocity-time integral （LVOT VTI） become possible，which is superior to CVP in reflecting volume responsiveness as it is similar to the stroke volume. Objective　To examine the clinical value of LVOT VTI in guiding fluid therapy for COPD patients with septic shock. Methods　COPD patients with septic shock were selected from the Intensive Care Unit，Northern Jiangsu People's Hospital of Jiangsu Province from March 2017 to June 2018，and randomized into CVP group（treated with fluid therapy guided by CVP，till CVP reaching 15 mm Hg），global end-diastolic volume index（GEDVI） group（treated with fluid therapy guided by GEDVI，till GEDVI reaching 800 ml/m2），and VTI group （treated with fluid therapy guided by LVOT VTI，till the increase of LVOT VTI <15%）. Baseline data（age，gender，APACHEⅡ score，SOFA score，mean arterial pressure，CVP，blood lactate，oxygenation index，and pulmonary hypertension prevalence at ICU admission），fluid treatment-related data （the volume of fluid administered and norepinephrine dosage during the first six and 24 hours of resuscitation，blood lactate level and blood lactate clearance during the first 24 hours of resuscitation，APACHEⅡ score and SOFA score during the first 72 hours of resuscitation），renal replacement therapy rate，mechanical ventilation time，ICU hospital stay，and in-hospital mortality were compared between the groups. Results　Three groups showed statistically significant differences in the volume of fluid administered and norepinephrine dosage during the first 24 hours of resuscitation（P<0.05），but showed no significant differences in the volume of fluid administered and norepinephrine dosage during the first six hours of resuscitation，blood lactate level and blood lactate clearance during the first 24 hours of resuscitation，APACHE Ⅱ score and SOFA score during the first 72 hours of resuscitation，renal replacement therapy rate，mechanical ventilation time，ICU hospital stay，and in-hospital mortality（P>0.05）. CVP group received less volume of fluid during the first 24 hours of resuscitation than other groups（P<0.05）. VTI group used less norepinephrine dosage during the first 24 hours of resuscitation than other groups（P<0.05）. Conclusion　LVOT VTI used in fluid therapy may help to evaluate the required fluid volume more accurately and reduce the dosage of norepinephrine more significantly，so it may have a good clinical application prospect.

Key words: Pulmonary disease, chronic obstructive；Shock；Velocity time integral；Global end-diastolic volume index；Fluid therapy；Treatment outcome