脉搏指数连续心排血量监测在脓毒性休克早期液体复苏中的临床价值

The clinical value of pulse Index continuous cardiac output monitoring in early fluid resuscitation of septic shock

目的研究脉搏指数连续心排血量监测在脓毒性休克早期液体复苏中的临床价值。方法选取2011年5月—2013年5月期间我院收治的脓毒性休克患者40例,按照随机数字表法分为研究组和对照组,每组20例。两组患者均给予抗感染治疗,研究组在脉搏指数连续心排血量监测下进行治疗,对照组在中心静脉压的指导下进行治疗,比较两组复苏6h和24h后患者血乳酸值低于2mmol/L和中心静脉氧饱和度超过70%的比例、机械通气时间、24h复苏液体量、肺水肿的发生率及去甲肾上腺素的用量。结果复苏6h后,研究组血乳酸值低于2mmol/L和中心静脉氧饱和度超过70%的比例分别为40.0%、35.0%,对照组分别分35.0%和30.0%,两组比较差异无统计学意义(χ2=0.11,0.11,P>0.05);复苏24h后研究组和对照组血乳酸值低于2mmol/L和中心静脉氧饱和度超过70%的比例分别为85.0%、85.0%和50.0%、55.0%,两组比较差异具有统计学意义(χ2=5.58,4.29,P<0.05);研究组机械通气时间、24h复苏液体量以及去甲肾上腺素用量显著优于对照组,差异具有统计学意义(t=11.03,10.98,11.26,P<0.05);研究组肺水肿发生率为5.0%,显著低于对照组,两组比较差异具有统计学意义(χ2=7.03,P<0.05)。结论脉搏指数连续心排血量监测能够较好地指导患者早期液体复苏治疗,改善患者临床症状。

Objective To study the clinical value of pulse Index continuous cardiac output monitoring in early fluid resuscitation of septic shock.Methods 40 cases of patients with septic shock were selected in our hospital in May 2011 to May 2013,they were divided into study group and control group according to a random number table methods with20 cases in each group.All patients were given anti-infection treatment,The patients of the study group were treated in continuous cardiac output index pulse monitored,The patients of control group were treated under the guidance of central venous pressure,The ratio of patients whose lactic acid level〈2mmol/L and central venous oxygen saturation≥70% after 6hand 24 hof resuscitation,mechanical ventilation time,24 hrecovery liquid volume,occurrence rate of pulmonary edema and the amount of noradrenaline were compared between two groups.Results After 6hof resuscitation,the lactic acid level〈2mmol/L and central venous oxygen saturation≥70% at the study group were 40.0%（8/20）、35.0%（7/20）,the control group were 35.0%（7/20）and 30.0%（6/20）,the difference between the two groups had no statistically significant（χ2=0.11,0.11,P〉0.05）;after 24 hof resuscitation,the lactic acid level〈2mmol/L and central venous oxygen saturation≥70% of two groups were 85.0%（17/20）、85.0%（17/20）and 50.0%（10/20）、55.0%（11/20）,the difference between the two groups had statistically significant（χ2=5.58,4.29,P〈0.05）;the duration of mechanical ventilation,24 hresuscitation fluid volume and the amount of noradrenaline of the study group were significantly better than the control group,the difference between the two groups had statistically significant（t=11.03,10.98,11.26,P〈0.05）;The incidence of pulmonary edema of the study group was 5.0%,significantly lower than 40.0% of the control group,the difference between the two groups had statistically significant（χ2=7.03,P〈0.05）.Conclusion Pulse Index continuous cardiac output monitoring can better guide early fluid resuscitation and improve the symptoms.