PICCO技术指导限制性液体复苏在严重创伤失血性休克抢救中的应用

Application of PICCO-guided limited fluid resuscitation in rescue of severe traumatic hemorrhagic shock

目的探究脉波指示剂连续心排量监测(PICCO)技术指导限制性液体复苏在严重创伤失血性休克抢救中的应用效果。方法将西安高新医院急诊科于2018年4月至2019年3月收治的111例严重创伤伴失血性休克患者作为观察组,另选择2017年4月至2018年3月收治的105例严重创伤伴失血性休克患者作为对照组。观察组患者在PICCO技术的指导下进行限制性液体复苏,对照组患者则在传统监测技术下进行限制性液体复苏。比较两组患者治疗前后的各项生命体征指标[心脏指数(CI)、心率(HR)、中心静脉压(CVP)、平均动脉压(MVP)、氧和指数(PaO2/FiO2)、血乳酸(LAC)]以及急性生理与慢性健康(APACHEⅡ)评分、液体复苏及预后情况。结果治疗前,两组患者的CI、HR、CVP、MVP、PaO2/FiO2、LAC以APACHEⅡ评分比较差异均无统计学意义(P>0.05);观察组患者治疗后3 d的CI、CVP、MVP和PaO2/FiO2水平分别为(5.57±0.91)L/(min·m2)、(12.64±2.04)mmHg、(76.28±8.49)mmHg、306.31±23.26,明显高于对照组的(4.64±0.74)L/(min·m2)、(10.82±1.73)mmHg、(70.11±7.26)mmHg、278.46±21.06,HR、LAC及APACHEⅡ评分分别为(90.23±6.23)次/min、(1.35±0.23)mmol/L、(18.14±1.59)分,明显低于对照组的(102.57±8.16)次/min、(1.88±0.41)mmol/L、(21.46±2.03)分,差异均有统计学意义(P<0.05);观察组患者的72 h复苏液体总量、输血量、去甲肾上腺素用量、多巴胺用量、凝血酶原时间、部分凝血活酶时间、机械通气时间及ICU住院时间明显少于或短于对照组,差异均有统计学意义(P<0.05);观察组患者病死率和并发症总发生率分别为4.50%、8.11%,明显低于对照组的16.19%和21.90%,差异均有统计学意义(P<0.05)。结论PICCO监测技术在指导严重创伤失血性休克患者限制性液体复苏方面较传统监测技术更加精确,其能够在短时间内纠正其休克状态,提高心肺功能,对于指导血管活性药物的应用、预后改善以及减少并发症和病死率均能够发挥积极作用。

Objective To study the application of pulse-indicator continuous cardiac output monitoring(PICCO)-guided limited fluid resuscitation in rescue of severe traumatic hemorrhagic shock.Methods A total of 111 patients with severe traumatic hemorrhagic shock admitted to Emergency Department,Xi'an High Tech Hospital,from April 2018 to March 2019 were selected as the observation group,and 105 patients with severe traumatic hemorrhagic shock admitted to Emergency Department,Xi'an High Tech Hospital from April 2017 to March 2018 were selected as the control group.The patients in the observation group were treated with limited fluid resuscitation under the guidance of PICCO technology,and the patients in the control group received limited fluid resuscitation under the traditional monitoring technology.The vital signs,including cardiac index(CI),heart rate(HR),central venous pressure(CVP),mean arterial pressure(MVP),oxygen and index(PaO2/FiO2),blood lactic acid(LAC),and acute physiology and chronic health(APACHEⅡ)scores were compared between the two groups before and after treatment.Results Before the treatment,there were no significant differences in CI,HR,CVP,MVP,PaO2/FiO2,LAC,and APACHEⅡscores between the two groups(P>0.05);the levels of CI,CVP,MVP,and PaO2/FiO2 in the observation group were(5.57±0.91)L/(min·m2),(12.64±2.04)mmHg,(76.28±8.49)mmHg,306.31±23.26,which were significantly higher than(4.64±0.74)L/(min·m2),(10.82±1.73)mmHg,(70.11±7.26)mmHg,278.46±21.06 in the control group;HR,LAC,and ApacheⅡscore in the observation group were(90.23±6.23)times/min,(1.35±0.23)mmol/L,18.14±1.59,which were significantly lower than(102.57±8.16)times/min,(1.88±0.41)mmol/L,21.46±2.03 in the control group;the differences between the groups were statistically significant(P<0.05).The total volume of resuscitation fluid in 72 hours,blood transfusion volume,noradrenaline,dopamine,prothrombin time,partial thromboplastin time,mechanical ventilation time,and ICU hospitalization time in the observation group were significantly less or shorter than those of the control group,and the differences were statistically significant(P<0.05).The fatality rate and total complication rate of patients in the observation group were 4.50%and 8.11%,which were significantly lower than 16.19%and 21.90%of the control group(P<0.05).Conclusion PICCO monitoring technology is more accurate than the traditional monitoring technology in guiding the limited fluid resuscitation of patients with severe traumatic hemorrhagic shock,which can correct the shock state in a short time,improve the cardiopulmonary function,and play a positive role in guiding the application of vasoactive drugs,improving the prognosis and reducing complications and mortality.