脉波轮廓温度稀释连续心排量测量在脓毒症合并急性呼吸窘迫综合征患者中的临床应用价值

Clinical values of PICCO in management of sepsis and acute respiratory distress syndrome

目的比较脉波轮廓温度稀释连续心排量测量(PICCO)和中心静脉压(CVP)在脓毒症合并急性呼吸窘迫综合征(ARDS)患者中的临床应用价值。方法前瞻性收集2013年1月-2015年12月江苏省昆山市第一人民医院收治的脓毒症合并ARDS的患者120例。根据完全随机对照原则将患者随机分为PICCO组和CVP组,分别在PICCO和CVP的指导下进行早期液体复苏。主要观察指标为临床结局、临床干预措施和主要并发症。结果 PICCO组患者死亡率、住院时间、ICU停留时间、短暂性多脏器功能衰竭率、持续器官功能衰竭率、急性肾功能损伤分级、抗生素使用时间、机械通气使用时间和及持续血液滤过时间与CVP比较,差异有统计学意义(P<0.05)。两组患者ARDS严重程度分级、血管活性药物使用率、输血率、机械通气率及持续血液滤过率比较,差异无统计学意义(P>0.05)。结论 PICCO监测改善脓毒症合并ARDS患者临床预后。

Objective To compare the clinical values of pulse indicator continuous cardiac output （PICCO） and central venous pressure （CVP） in the management of sepsis and acute respiratory distress syndrome （ARDS）. Methods From Jan. 2013 to Dec. 2015, 120 patients with sepsis and ARDS were enrolled in this prospective study. According to the completely randomized control principle （1 ：1）, the patients were signed into PICCO group or CVP group. The patients in the PICCO group received early fluid resuscitation under the guidance of PICCO while the patients in the CVP group received early fluid resuscitation under the guidance of CVP. The primary outcomes included long-term clinical outcomes, clinical interventions and major complications. Results The patients in the two groups had significant differences in the mortality, the hospital duration, the intensive care unit duration, the rate of transient multiple organ dysfunction, the rate of persistent multiple organ dysfunction, the grading of acute kidney injury, the antibiotic use duration, the mechanical ventilation duration and continuous blood filtration time （ P〈0.05）. There was no significant difference between the two groups in the severity classification of ARDS, the rate of vasoactive drug use, the blood transfusion rate, the rate of mechanical ventilation or the rate of continuous blood filtration （P〉0.05）. Conclusions PICCO improves the clinical outcomes of patients with sepsis and ARDS. It is worthy of worldwide spreading.