脉搏指示连续心排血量监测在感染性休克早期液体复苏中的应用

The value of pulse-indicate continuous cardiac output in septic shock patients

目的探讨脉搏指示连续心排血量（PICCO）监测技术在感染性休克患者液体复苏中的应用价值。方法2010年1月至2011年12月58例感染性休克患者根据治疗过程中是否应用PICCO监测技术将患者分为PICCO组（28例）和对照组（30例），对比分析两组患者治疗后早期目标导向治疗的液体复苏（EGDT）达标率、乳酸水平、中心静脉压（CVP）、氧合指数，72h内液体入量、液体平衡、ICU内呼吸机应用时间、ICU住院时间、ICU内72h后多脏器功能不全（MODS）发生率、28d病死率。结果（1）与对照组比较，PICCO组72h内总的液体人量[（9565±1623）ml与（12245±2253）ml，t=2．673，P=0．021]及正平衡[（3656±1904）ml与（5465±2765）ml，t=2．357，P=0．012]较对照组明显减少。（2）PICCO组72h氧合指数较对照组明显增高（252．6±87．4与226．8±69．4，P〈0．05），呼吸机应用时间较对照组明显缩短[（134．7±42．8）h与（193．3±92．4）h，t=1．356，P=0．023]。（3）两组在相同时间段乳酸水平、CVP值、6hEGDT达标率、ICU住院时间、72h后ICU内MODS发生率、28d病死率方面比较差异均无统计学意义（P均〉0．05）。结论与CVP指导的常规液体复苏相比，PICCO监测技术可以更准确地对感染性休克患者进行容量管理，指导早期液体复苏。

Objective To investigate the value of pulse-indicate continuous cardiac output（PICCO） in septic shock patients. Methods In a retrospective study,58 patients who were diagnosed to be suffering from septic shock in the intensive care unit （ICU） were enrolled, from January 2010 to December 2011, and were divided into two groups ：PICCO group（ n = 28 ） and the conventional group （n = 30）. We compared their 6 h- EGDT compliance rate, the level of lactate and central venous pressure （CVP）, the oxygenation index, the characteristics of fluid intake and balance within 72 hours, duration of mechanical ventilation, and ICU stay of the two groups. The incidence of MODS after 72 hours in ICU, 28-day mortality were recorded and compared. Results （I） Fluid intake（（9565 ±1623） ml vs （12 245±2253） ml,t =2.673,P=0..021） and balance（ （3656 ± 1904） ml vs （ 5465 ± 2765 ） ml, t = 2. 357, P = 0. 012） were significantly lower in PICCO group compared the conventional group within 72 hours. （ 2 ） The oxygenation index （ （ 252.＇6 ± 87.4 ） vs （226. 8 ± 69. 4 ）, P 〈 O. 05 ） in PICCO group increased significantly and duration of mechanical ventilation （ （ 134. 7 ± 42. 8 ） h vs （ 193.3 ± 92.4 ） h, t = 1. 356, P = 0. 023 ） reduced significantly compared with the conventional group after 72 hours. （3） There was no difference in the 6 h-EGDT compliance rate, the level of lactate and CVP,6 h EGDT, ICU stay, the incidence rate of MODS after 72 hours ,28-day mortality in ICU（ P 〉 O. 05 ）. Conclusion In contrast＇ with classic methods as CVP monitoring, PICCO catheter may assess more accurately the volume status and guide early fluid resuscitation in septic shock patients.