脉搏指示连续心排血量监测技术在大面积烧伤患者中的应用效果及护理

Application effect and nursing of pulse indicator continuous cardiac output monitoring technology in large area burn patients

目的探讨脉搏指标连续心排血量监测(PICCO)技术在大面积烧伤患者中的应用效果和护理方法。方法选择医院2014年1月至2017年6月收治的82例大面积烧伤患者作为研究对象,按照随机数字表法将其分为观察组与对照组各41例。2组患者均采用相同的治疗方法,其中对照组采用常规监测方法指导液体复苏,观察组在此基础上采用PICCO监测技术指导液体复苏。对2组患者的血流动力学指标、液体复苏时间、ICU天数、并发症发生率、病死率等指标进行对比分析。结果液体复苏后,观察组急性生理学与慢性健康状况系统Ⅱ(APACHEⅡ)评分、心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)分别为(18.4±4.2)分、(98.7±8.5)次/min、(88.5±9.6)mmHg(1 mmHg=0.133 kPa)、(10.3±2.5)mmHg,对照组APACHEⅡ评分、HR、MAP、CVP分别为(22.7±5.4)分、(112.5±9.6)次/min、(81.2±10.5)mmHg、(7.9±2.2)mmHg,2组比较差异有统计学意义(t=3.285~6.891,均P<0.05);观察组液体复苏后心指数(CI)、心排血量(CO)、全心舒张末期容积指数(GEDVI)、胸腔内血容量指数(ITBVI)、血管外肺水指数(EVLWI)分别为(4.21±0.46)L·min^-1·m^-2、(4.87±0.52)L/min、(734.51±95.83)ml/m2、(725.91±88.42)ml/m2、(6.26±1.21)ml/kg,与复苏前比较差异有统计学意义(t=10.454~21.143,均P<0.05);观察组复苏达标时间和ICU天数分别为(3.1±1.2)、(31.4±5.8)d,对照组复苏达标时间和ICU天数分别为(3.9±1.5)、(37.8±6.5)d,2组比较差异有统计学意义(t=2.667、4.704,均P<0.05)。结论在大面积烧伤患者的治疗中采用PICCO监测对早期液体复苏具有重要的指导作用,加强护理工作有利于患者的针对性治疗和康复。

Objective To explore the application effect and nursing methods of pulse indicator continuous cardiac output (PICCO) monitoring technology in large area burn patients. Methods A total of 82 cases of large area burn patients in the hospital from January 2014 to June 2017 were chosen and divided into experimental group (41 cases) and control group (41 cases) by random digits table method. Two groups of patients were treated with the same method, the control group using routine monitoring method to guide liquid resuscitation, the experimental group based on the use of PICCO monitoring technology to guide fluid resuscitation. Hemodynamic indexes, fluid resuscitation time, ICU days, complication rate and mortality rate of the two groups were compared and analyzed. Results After fluid resuscitation, the acute physiology and chronic health system II (APACHE II) score, heart rate (HR), mean arterial pressure (MAP) and central venous pressure (CVP) of the observation group were (18.4±4.2) marks, (98.7±8.5) once/min, (88.5±9.6) mmHg (1 mmHg=0.133 kPa), (10.3±2.5) mmHg.The APACHE II score, HR, MAP and CVP of the control group were (22.7±5.4) marks, (112.5±9.6) once/min, (81.2±10.5) mmHg, (7.9±2.2) mmHg. There were significant differences between the two groups (t=3.285-6.891, all P<0.05). The cardiac index (CI),cardiac output(CO), global end-diastolic volume index (GEDVI), intrathoracic blood volume index(ITBVI), extravascular pulmonary water index(EVLWI) of the observation group after fluid resuscitation were (4.21±0.46) L·min^-1·m^-2, (4.87±0.52) L/min, (734.51±95.83) ml/m2, (725.91±88.42) ml/m2, (6.26±1.21) ml/kg, respectively. The difference was statistically significant compared to those before fluid resuscitation (t=10.454-21.143, all P<0.05).Resuscitation time and ICU days in the observation group were (3.1±1.2), (31.4±5.8) d. Resuscitation time and ICU days in the control group were (3.9±1.5), (37.8±6.5) d. There were significant differences between the two groups (t=2.667, 4.704, P<0.05). Conclusions PICCO monitoring plays an important role in the early fluid resuscitation in the treatment of large area burn patients, and strengthening the nursing work is beneficial to the targeted treatment and rehabilitation of the patients.