目标导向液体管理护理在ICU重症患者中的实施及成效分析

Implementation and Effectiveness Analysis of Goal-Directed Fluid Management Nursing in ICU Patients

摘要: 目的：探讨目标导向液体管理护理(GDFM)在ICU重症患者中的应用效果，评估其在改善血流动力学、液体平衡及减少并发症方面的作用。方法：本研究采用随机数表法，纳入2023年9月至2024年9月收治的90名ICU重症患者，分为观察组和对照组，每组45例。对照组接受常规液体管理护理，观察组在此基础上应用GDFM护理，通过中心静脉压(CVP)、平均动脉压(MAP)、血乳酸浓度和每小时尿量等动态指标进行个体化调整。比较两组患者在血流动力学、液体平衡和并发症发生率等方面的差异。结果：观察组患者的CVP、MAP、血乳酸浓度和每小时尿量均显著优于对照组(P<0.01)，且每日液体平衡显著低于对照组(P<0.01)，表明观察组液体管理更加精准，液体滞留更少。同时，两组并发症发生率无显著差异(P>0.05)，显示GDFM护理的安全性。结论：GDFM护理能够有效改善ICU重症患者的血流动力学状态，优化液体平衡，促进肾功能恢复，对提升重症患者预后具有重要意义，值得临床推广应用。

Abstract: Objective: To investigate the efficacy of goal-directed fluid management care (GDFM) in ICU patients with severe illness, and to evaluate its role in improving hemodynamics, fluid balance and reducing complications. Methods: In this study, 90 critically ill ICU patients admitted from September 2023 to September 2024 were divided into observation group and control group, with 45 cases in each group. The control group received routine fluid management care, and the observation group was treated with GDFM care on the basis of which individual adjustments were made by dynamic indicators such as central venous pressure (CVP), mean arterial pressure (MAP), blood lactate concentration and hourly urine volume. The differences in hemodynamics, fluid balance and complication rate between the two groups were compared. Results: The CVP, MAP, blood lactate concentration and hourly urine volume of the observation group were significantly better than those of the control group (P < 0.01), and the daily fluid balance was significantly lower than that of the control group (P < 0.01), indicating more accurate fluid management and less fluid retention in the observation group. At the same time, there was no significant difference in complication rate between the two groups (P > 0.05), indicating the safety of GDFM nursing. Conclusion: GDFM nursing can effectively improve the hemodynamic status, optimize fluid balance and promote the recovery of renal function in ICU patients with severe illness, which is of great significance for improving the prognosis of patients with severe illness, and is worthy of clinical promotion and application.