连续心排血量监测技术血液流动力学监测联合床旁超声在重症急性胰腺炎中的应用

Application of PICCO combined with bedside B-ultrasonic examination in severe acute pancreatitis

目的探讨急诊床旁B超联合脉博连续心输出量(PICCO)血流动力学监测在重症急性胰腺炎(SAP)治疗的临床应用。方法 2013年10月至2015年12月本院急诊科接诊的56例SAP患者临床资料,按随机数字表法分为试验组和对照组各28例。对照组采用常规多参数无创监测方法,试验组采用B超联合PICCO血液流动力学监测。记录试验组B超声像特征,比较两组的PICCO监测指标及APACHEⅡ评分、机械通气时间、入住ICU天数、一次穿刺成功率、并发症发生率及治愈率。结果治疗前后试验组B超声像特征差异显著,两组治疗前后各指标均有显著差异,且治疗后试验组的入液量、HR、MAP、EVLWI及Pa O2/Fi O2增高或降低比率均优于对照组,差异有显著统计学意义,同时治疗后试验组的APACHEⅡ评分、机械通气时间、住ICU天数、一次穿刺成功率、并发症发生率、治愈率也显著优于对照组。结论急诊床旁B超联合PICCO血液流动力学监测可明显改善重症急性胰腺炎的治疗效果及预后,值得在临床上进一步推广应用。

Objective To investigate the application of bedside B-ultrasonic examination combined with PICCO in monitoring severe acute pancreatitis （SAP）. Methods The clinical data of 56 patients with SAP from October 2013 to December 2015 in our EICU were randomly divided into control or experiment group,28 in eaeh group. In the control group, patients were given multi-parameter noninvasive monitoring white patients in the experiment group were given bedside B-ultrasonic examination combined with PICCO monitoring. Ultrasound findings were recorded in the experiment group. The PICCO monitoring indicators, APACHE Ⅱ scores, duration of mechanical ventilation, length of stay in ICU, success rate of one-time catheterization, incidence of complication and recovery rate were compared between the two groups. Results The ultrasound findings were significant differences before and after treatment in the experiment group. All parameters were significantly different before and after treatment in the two groups. After treatment, the intake vol- ume, HR, MAP, EVLWI and PaO2/FiO2 in the experiment group were better than that in the control group. Moreover, APACHE Ⅱ , duration of mechanical ventilation, length of stay in ICU, success rate of one-time catheterization, incidences of complication and recovery rate in the experiment group were also much better than that in control group. Conclusion Application of bedside B-ultrasonic examination combined with PICCO monitoring can improve clinical prognosis of patients with SAP. It is worthy for clinical promotion.