PiCCO监测在感染休克早期液体复苏中的应用研究

Application research on PiCCO monitoring in fluid resuscitation of early infection shock

目的探讨PiCCO监测在感染休克早期液体复苏中的应用效果。方法 90例感染休克患者根据随机数字表法分为治疗组与对照组,各45例,治疗组采用PiCCO监测仪记录胸腔内血容积指数(ITBVI)、心脏指数(CI)、外周血管阻力指数(SVRI)、血管外肺水指数(EVLWI),依据PiCCO血流动力学数据分型对患者进行个体化治疗及疗效评估;对照组采用常规液体复苏治疗和疗效评估。观察并记录治疗组治疗前和治疗后30 min、2 h、4 h及12 h的ITBVI、CI、SVRI、EVLWI,并记录两组治疗前和治疗后24 h乳酸水平、中心静脉血氧饱和度(ScvO2)、排尿量及死亡率。结果治疗组治疗后30 min、2 h、4 h及12 h的ITBVI、CI及EVLWI高于治疗前,治疗后12 h的SVRI高于治疗前,差异有统计学意义(P<0.05)。治疗后24 h,两组ScvO2、乳酸水平、排尿量较治疗前均有改善,差异有统计学意义(P<0.05);观察组治疗后24 h的ScvO2、乳酸水平、排尿量较对照组改善明显,差异有统计学意义(P<0.05)。两组死亡率对比差异有统计学意义(P<0.05)。结论 PiCCO监测应用于感染休克早期液体复苏能快速有效地改善机体组织灌注,有重要的临床指导意义。

Objective To investigate the application effects of PiCCO monitoring in the fluid resuscitation of early in-fection shock. Methods Ninety patients with infection shock were divided into treatment group and control group ac-cording to the random number table method,with 45 patients in each group.PiCCO monitor was used to record the in-trathoracic blood volume index（ITBVI）,cardiac index（CI）,systemic vascular resistance index（SVRI）and extravascular lung water index（EVLWI）,and the patients were given personalized treatment and efficacy evaluation according to the PiCCO hemodynamic data type in treatment group.The conventional fluid resuscitation treatment and efficacy evaluation were used in control group.Before treatment and after treatment of 30-minute,2-hour,4-hour and 12-hour,ITBVI,CI,SVRI and EVLWI of treatment group was observed and recorded respectively,and before treatment and after treatment of 24-hour,lactate level,central venous oxygen saturation,urine output and mortality rate of both groups was recorded respec-tively. Results After treatment of 30-minute,2-hour,4-hour and 12-hour,ITBVI,CI,SVRI and EVLWI of treatment group was higher than that before treatment respectively,SVRI of treatment group after treatment of 12-hour was higher than that before treatment,with statistical difference （P〈0.05）.After treatment of 24-hour,improvement of lactate level, central venous oxygen saturation and urine output in both groups was better than that before treatment respectively,with statistical difference （P〈0.05）.After treatment of 24-hour,improvement of lactate level,central venous oxygen saturation and urine output in treatment group was significantly better than that in control group respectively,with statistical differ-ence（P〈0.05）.The two groups had statistical difference in mortality rate（P〈0.05）. Conclusion PiCCO monitoring applied in the fluid resuscitation of early infection shock can improve the body’s tissue perfusion rapidly and effectively and has important clinical significance.