Flotrac/Vigileo在行连续性肾脏替代治疗的严重脓毒症患者容量监测中的应用

Application of Flotrac / Vigileo to capacity monitoring in severe sepsis patients with CRRT

目的将Flotrac/Vigileo(Edwards Lifesciences,USA)监测应用于行连续性肾脏替代治疗(CRRT)的严重脓毒症患者,评价其对该类患者临床各指标的影响,减少液体过度负荷或隐匿性低血容量所带来的并发症,改善微循环,加快器官功能恢复最终改善预后。方法收集96例行CRRT治疗的严重脓毒症患者,数字表法随机分成两组,每组48例,常规治疗组(A组)和Flotrac/Vigileo监测组(B组),两组患者均给予严重脓毒症的常规治疗,包括积极处理原发病、广谱抗生素、脏器支持治疗。留置中心静脉导管,CRRT治疗使用Aquarius连续性血液净化系统(Edwards Lifesciences,USA),采用连续性静-静脉血液滤过(CVVH)模式持续治疗3 d。A组根据患者平均动脉压(MAP)、尿量超滤量、血清乳酸水平(LAC)及中心静脉压(CVP)等行常规液体治疗,B组采用Flotrac/Vigileo技术持续测量心脏指数(CI),心搏量指数(SVI),每搏变异度(SVV),SVV≥12%补充液体,降低超滤率,SVV<12%采用逐步滴定法给予液体治疗并提高超滤率。观察患者脏器功能指标及血流动力学指标、住院时间及死亡率情况。结果与A组相比,B组患者治疗72 h时后MAP、LAC、氧合指数(PaO_2/FiO_2)、肌酐(GREA)、APACHE II评分均较A组改善明显,其中Pa O2/Fi O2、LAC、GREA差异有统计学意义;B组ICU住院时间短于A组,差异有统计学意义;死亡率15.1%低于A组16.2%,但差异无统计学意义。结论将Flotrac/Vigileo监测用于行CRRT的严重脓毒症患者,指导其进行严格的容量控制,有利于改善脏器功能,减少CRRT治疗并发症。

Objective To evaluate the effect of Flotrac / Vigileo（ Edwards Lifesciences,USA） monitoring on clinical indexes of severe sepsis patients with continuous renal replacement therapy（ CRRT）,so as to improve the prognosis by reducing complications caused by liquid excessive load or dormant low blood volume,improving microcirculation and enhancing organic functional recovery. Methods Totally 96 severe sepsis patients treated with CRRT were randominzed into 2 groups,conventional treatment group（ group A,n = 48）and Flotrac / Vigileo monitoring group（ group B,n = 48）. Patients in both groups were given conventional treatment of severe sepsis,including active treatment of the primary disease,broad- spectrum antibiotics,organ support therapy. With indwelling central venous catheter,the Aquarius continuous blood purification system（ Edwards Lifesciences,USA） was adopted and CVVH model treatment was conducted for a successive 3 days. Conventional liquid treatment was conducted in group A based on MAP,ultrafiltration volume of urine,LAC and CVP,while in group B Flotrac / Vigileo was adopted for measuring CI,SVI,SVV. Fluid was added when SVV≥12% and ultrafiltration rate was decreased. Stepwise titration method was used for fluid therapy when SVV 12% and ultrafiltration was increased. Patients＇ visceral function index,hemodynamic indexes,length of hospital stay and mortality were observed. Results MAP,LAC,PaO2/FiO2,GREA,APACHE II score of group B after 72- hour treatment improved more obviously than group A,of which differences in PaO2/ FiO2,LAC,GREA were statistically significant. Patients＇ length of stay in ICU in group B was shorter than in group A,which showed statistically significant difference. The mortality rate in group B was 15. 1%,which showed no statistically significant difference from group A（ 16. 2%）. Conclusions Flotrac / Vigileo monitoring used in severe sepsis patients with CRRT can improve visceral function and reduce complication of CRRT via strict capacity control.