PICCO监测和CVP压力监测指导下的重型颅脑损伤患者液体复苏疗效的比较研究

Comparison study of the effects of using PICCO monitoring and CVP pressure monitoring to instruct fluid resuscitation in patients with severe traumatic brain injury

目的比较分析PICCO监测和CVP压力监测指导下重型颅脑损伤患者液体复苏的疗效。方法选取2012年1月至2014年6月本院收治因颅脑重型损伤患者100例,按照动态随机分组法随机分为PICCO组和CVP组,每组50例;PICCO组患者在PICOO监测指导下进行液体复苏治疗,而CVP组患者则在CVP监测指导下进行液体复苏治疗;比较两组患者治疗时间、颅脑恢复率、肺水肿出现率、生存率以及住院期间格拉斯哥昏迷评分(GCS)的数值变化等。结果 PICCO组颅脑恢复良好率为68%,显著高于CVP组的28%,两者间差异具有统计学意义(χ2=16.026,P<0.05);PICCO组脑水肿出现7例少于CVP组的11例,但两组比较无差异(χ2=1.084,P>0.05);PICCO组治疗时间为(16.7±5.7)天显著性低于CVP组的(21.5±6.3)天(t=3.067,P<0.05);但PICCO组死亡3例,生存率为94.0%显著性高于CVP组的56.0%(χ2=19.253,P<0.05)。两组在诊治之前,GCS无显著差异(P>0.05),诊治之后,PICCO组患者GCS数值变动与CVP组对比优越很多,两组GCS数值变动在诊治1天之时、诊治1周之时、诊治2周之时均有统计学意义(均P<0.05)。结论采用PICCO监测能更加快速准确地评估重型颅脑损伤患者的血容量状态,显著提高重型颅脑损伤患者的抢救成功率,对其液体管理具有重要的临床价值。

Objective To compare and analyze the fluid resuscitation effects of using PICCO and CVP to monitoring severe traumatic brain injury.Methods From January 2012 to June 2014 in our hospital,100 patients with severe traumatic brain injury were selected and divided into the PICCO group and CVP group according to the dynamic random grouping method（50 cases in each group）.Patients in the PICCO group had liquid recovery treatment under the guidance of PICCO monitoring,while the CVP group had liquid recovery treatment under the guidance of CVP monitor-ing.The treatment time,cerebral recovery rate,pulmonary edema rate,survival rate and hospitalization Glasgow Coma Scale（GCS） changes of the two groups were recorded and compared.Results Good brain recovery rate of the PICCO group was 68%.It is higher than that of CVP groups（28%）with statistically significant difference（χ^2=16.026,P〈0.05）.There were 7 cases of brain edema in the PICCO group which was less than the CVP group＇s 11 cases,without significant differences（χ2=1.084,P1.084）.Treatment time in PICCO group was（16.7 ±5.7） d which was significantly lower than（21.5±6.3） d in the CVP group（t=3.067,P0.05）.The survival rate in PICCO group was 94.0% which was significant higher than 56.0% in CVP group（χ^2=19.253,P0.05）.GCS before treatment had no significant difference in the two groups（ P〉0.05）.GCS after treatment and its numerical changes at 1 day,1 week and 2 weeks in the PICCO group were significantly better than those in the CVP group（ P〈0.05）.Conclusion Using PICCO monitoring could more quickly and accurately assess the blood volume in patients with severe craniocerebral injury,and improve the rescue success rate of severe craniocerebral injury patients,which has important clinical value of liquid management.