基于跨肺热稀释的血流动力学监测治疗脓毒性休克患者的临床研究

Clinical study on hemodynamic monitoring of patients with septic shock based on transpulmonary thermal dilution

目的通过对比基于跨肺热稀释(transpulmonary thermal dilution,TPTD)的脉搏指示连续心输出量监测(pulse index continuous cardiac output,PiCCO)指导治疗与中心静脉压(central venous pressure,CVP)指导治疗,评估TPTD技术应用于脓毒性休克患者治疗的有效性,探索TPTD技术影响脓毒性休克患者预后的价值。方法收集2019年1月至2020年1月复旦大学附属中山医院厦门医院的重症监护病房收治的脓毒性休克患者,根据血流动力学监测技术,将患者分为两组:PiCCO组和CVP组。比较两组之间的血管活性药物使用时间、液体平衡情况、28d死亡率、机械通气时间等。结果共入选脓毒性休克患者64例,PiCCO组32例,CVP组32例。PiCCO组血管活性药物使用时间少于CVP组(P<0.05);治疗第1天,PiCCO组乳酸低于CVP组(P<0.05)、乳酸清除率高于CVP组(P<0.05),治疗第2天,PiCCO组液体平衡低于CVP组(P<0.05);28d死亡率两组差异无统计学意义(P>0.05)。结论在指导脓毒性休克患者的治疗中,相比CVP监测,基于跨肺热稀释(TPTD)的血流动力学监测更有利于维持液体平衡,且减少了血管活性药物的使用时间。

Objective By comparing the treatment guided by pulse index continuous cardiac output(PiCCO)based on transpulmonary thermal dilution(TPTD)with that guided by central venous pressure(CVP),to evaluate the effectiveness of TPTD technique in the treatment of patients with septic shock,and explore the value of TPTD technique in influencing the prognosis of patients with septic shock.Methods Septic shock patients aged 18 years or older who were admitted to the intensive care unit of Xiamen Hospital,Zhongshan Hospital Affiliated to Fudan University from January 2019 to January 2020 were collected.According to hemodynamic monitoring techniques,the patients were divided into two groups:PiCCO group and CVP group.The duration of vasoactive drugs,fluid balance,28-day mortality and mechanical ventilation duration were compared between the two groups.Results Totally 64 patients with septic shock were enrolled,including 32 cases in PiCCO group and 32 cases in CVP group.The duration of vasoactive drug use in PiCCO group was less than that in CVP group(P<0.05).On the first day of enrollment,the lactic acid in PiCCO group was lower than that in CVP group(P<0.05),the clearance rate of lactic acid was higher than that of CVP group(P<0.05).On the second day of inclusion,fluid balance in the PiCCO group was lower than that in the control group(P<0.05).However,there was no significant difference in 28-day mortality between the two groups(P>0.05).Conclusions In guiding the treatment of patients with septic shock,hemodynamic monitoring based on transpulmonary thermodilution(TPTD)is more beneficial to maintaining fluid balance and reduces the duration of vasoactive agents compared to CVP monitoring.