Effect of a nurse-led fluid responsiveness monitoring protocol in preventing fluid accumulation syndrome in patients with septic shock

doi:10.3761/j.issn.0254-1769.2025.16.006

Abstract

Abstract:

Objective To develop a nurse-led dynamic monitoring protocol for fluid responsiveness and to evaluate its effectiveness in preventing fluid accumulation syndrome in patients with septic shock. Methods A nurse-led dynamic monitoring protocol for fluid responsiveness was developed through literature review and expert panel discussion. Using convenience sampling，160 patients with septic shock admitted to the emergency department of a tertiary hospital in Hangzhou，Zhejiang Province，were enrolled. According to admission period，80 patients admitted from November 2023 to August 2024 were assigned to an intervention group，and 80 patients admitted from January 2023 to October 2023 were assigned to a control group. The intervention group received the nurse-led dynamic monitoring in addition to routine care，while the control group received routine care and conventional fluid responsiveness monitoring. The therapeutic outcomes and incidence of complications were compared between the 2 groups. Results All 80 patients in each group completed the study. The intervention group demonstrated higher lactate clearance rates at 6 and 24 hours after fluid resuscitation，lower incidences of acute pulmonary edema and fluid accumulation syndrome，and shortened durations of mechanical ventilation and ICU stay（all P<0.05） compared to the control group. There was no statistically significant difference in 28-day mortality between the 2 groups（P=0.212）. Conclusion The nurse-led dynamic monitoring protocol for fluid responsiveness in patients with septic shock is both scientific and practical. Its implementation can effectively improve lactate clearance，reduce the incidence of fluid accumulation syndrome and acute pulmonary edema，and shorten the duration of mechanical ventilation and ICU stay.

Key words: Nurse, Septic Shock, Blood Volume, Fluid Accumulation Syndrome, Critical Care Nursing

摘要：

目的构建护士主导的液体反应性监测方案，探讨其在脓毒性休克患者液体积聚综合征预防中的应用效果。方法通过文献回顾和专家会议，制订护士主导的液体反应性动态监测方案。采用便利抽样法，选取浙江省杭州市某三级甲等医院急诊科收治的脓毒性休克患者160例作为研究对象，按入院时间将2023年11月—2024年8月收治的80例脓毒性休克患者作为试验组，2023年1—10月收治的80例脓毒性休克患者作为对照组。试验组在常规护理基础上实施护士主导的液体反应性动态监测方案，对照组采用常规护理和液体反应性监测。比较两组干预效果及并发症发生率。结果试验组与对照组各80例完成研究。相较于对照组试验组液体复苏6、24 h乳酸清除率升高、急性肺水肿和液体积聚综合征发生率下降、机械通气时长和ICU住院时长缩短（均P<0.05）。两组28 d病死率差异无统计学意义（P=0.212）。结论该研究构建的护士主导的液体反应性监测方案具有科学性及实用性，实施该方案可有效提高脓毒性休克患者的乳酸清除率，降低液体积聚综合征及急性肺水肿的发生率，缩短机械通气和ICU住院时长。

关键词: 护士, 脓毒性休克, 血管容量, 液体积聚综合征, 危重病护理

YE Lixia, XU Ye, LI Qin, JI Kexin, ZHOU Hong. Effect of a nurse-led fluid responsiveness monitoring protocol in preventing fluid accumulation syndrome in patients with septic shock[J]. Chinese Journal of Nursing, 2025, 60(16): 1959-1965.

叶丽霞, 许烨, 李琴, 计可欣, 周虹. 护士主导的液体反应性监测方案对预防脓毒性休克患者液体积聚综合征的效果研究[J]. 中华护理杂志, 2025, 60(16): 1959-1965.

Figures/Tables 3

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