重症超声技术在脓毒症相关并发症中的临床应用与研究进展

Clinical Applications and Research Advances of Critical Care Ultrasound in Sepsis-Related Complications

摘要: 脓毒症是一种由感染引起的全身性炎症反应，常伴随多个器官的功能障碍及病理损伤，是重症医学中的挑战性疾病之一。近年来，重症超声技术(Point-Of-Care Ultrasound, POCUS)凭借无创、实时、床旁可重复评估等特点，在脓毒症相关并发症的诊断、监测和治疗决策中得到广泛应用。本文综述了重症超声在脓毒症相关心功能障碍、急性呼吸窘迫综合征(ARDS)、急性肾损伤(AKI)、脓毒症性脑病(SAE)和肠道功能障碍与缺血中的应用，并重点补充其在多模态监测体系中的地位。通过经胸心脏超声、肺部超声、多普勒、CEUS和TCD等技术，临床医生不仅能够早期识别多系统并发症，还可将VTI、LVEF、B-lines、肾血流阻力指数等超声指标与心排量指数、SVV、乳酸、肌酐、氧合指数等有创或实验室指标相互印证，从而为液体复苏、血管活性药物调整、呼吸支持和器官灌注评估提供更完整的证据链。本文同时讨论了超声技术在实践中面临的挑战，如操作者依赖性强、标准化不足及高质量循证研究仍有限等。未来，随着人工智能和图像自动识别技术的发展，以及培训体系的完善，重症超声将在脓毒症个体化治疗和精准管理中发挥更加核心的作用。

Abstract: Sepsis is a systemic inflammatory response triggered by infection and is frequently accompanied by multiple organ dysfunction and pathological injury, making it one of the most challenging conditions in critical care. In recent years, point-of-care ultrasound (POCUS) has been widely applied in the diagnosis and management of sepsis-related complications because it is non-invasive, real-time, repeatable, and feasible at the bedside. This review summarizes the application of critical care ultrasound in sepsis-related cardiac dysfunction, acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), sepsis-associated encephalopathy (SAE), and gastrointestinal dysfunction and ischemia, with an additional focus on the role of POCUS within multimodal monitoring. By integrating transthoracic echocardiography, lung ultrasound, Doppler ultrasound, contrast-enhanced ultrasound (CEUS), and transcranial Doppler (TCD), clinicians can not only detect multi-organ complications early but also cross-validate ultrasound parameters such as VTI, LVEF, B-lines, and renal resistance indices with invasive hemodynamic variables and laboratory indicators including cardiac index, stroke volume variation, lactate, creatinine, and oxygenation indices. This multimodal approach provides a more comprehensive evidence chain for fluid resuscitation, vasoactive drug titration, respiratory support, and organ perfusion assessment. The review also discusses practical limitations of ultrasound, including operator dependence, insufficient standardization, and the need for more high-quality evidence. Looking ahead, with the development of artificial intelligence and automated image recognition technologies, as well as the improvement of training systems, critical care ultrasound is expected to play an increasingly central role in personalized treatment and precise management of sepsis.