分析脉波轮廓温度稀释连续心排量监测技术在感染性休克患者中液体复苏效果

Analysis on fluid resuscitation effect of pulse-indicated continuous cardiac output in patients with infectious shock

目的:分析脉波轮廓温度稀释连续心排量监测技术(PICCO)在感染性休克患者中的液体管理效果。方法:选择2014年9月~2016年10月入住ICU 96例感染性休克患者为研究对象,随机分为观察组50例和对照组48例;观察组采用PICCO监测指标(舒张末期容积指数、心输出量指数、血管外肺水指数、全身血管阻力、每搏量指数)指导液体管理,对照组采用传统方法(中心静脉压、心率、平均动脉压、尿量)指导液体管理。观察两组患者治疗24,72 h和心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、乳酸(Lac)、氧合指数(PaO_2/FiO_2)变化及去甲肾上腺素(NE)使用剂量变化;比较观察组患者液体管理治疗前、治疗24,72 h各项指标的变化;比较两组患者住ICU天数、机械通气天数。结果:观察组患者24,72 h心率、平均动脉压、中心静脉压、乳酸、氧合指数各指标明显优于对照组(P<0.05)。观察组治疗后的各指标明显优于治疗前(P<0.05)。观察组住ICU天数、机械通气天数比对照组明显缩短(P<0.05)。结论:PICCO监测技术简便、易行、在PICCO技术指导下进行可控的液体复苏,对于感染性休克患者能有效地改善血流动力学、组织灌注及氧代谢,减少血管活性药物用量,减少患者机械通气,缩短住ICU天数。

Objective：To analyze the fluid management effect of pulse - indicated continuous cardiac output （PICCO） in patients with infectious shock. Methods ：Selected 96 patients with infectious shock admitted in ICU from September 2014 to October 2016 as the research objects, and they were divided in- to 50 patients in the control group and 48 patients in the test group at random; in the observation group, PICCO monitoring indicators （ end - diastolic vol- ume index, cardiac output index, extravascular lung water index, systemic vascular resistance, stroke volume index） were used to guide the fluid manage- ment; and in the control group, the conventional methods （central venous pressure, heart rate, average venous pressure and urine volume） were used to guide the fluid management. Patients in the two groups were observed in change of heart rate, average venous pressure, central venous pressure, lactic acid, oxygenation index and use dosage of methylepinephrine at 24 h and 72 h after treatment; and comparison was made on patients in the two groups in terms of change of various indicators before treatment and 24 h and 72 h after treatment, and comparison was also made in days of stay in ICU, days of me- chanical ventilation. Results ： The heart rate, average venous pressure, central venous pressure, lactic acid and oxygenation index of patients in the observa- tion group at 24 and 72 h were significantly superior to those of patients in the control group （ P 〈 0.05 ）. After treatment, various indicators of patients in the observation group were significantly superior to those of patients in the control group （P 〈0.05）. The days of stay in ICU and days of mechanical venti- lation of patients in the observation group were shortened significantly compared with those of patients in the control group （P 〈0.05 ）. Couclusion：PlCCO monitoring technique was simple and easy to operate, and the controllable fluid resuscitation with the guidance of PICCO could effectively improve the hae- modynamics, tissue perfusion and oxygen metabolism of patients with infectious shock, reduce the use of vasoactive agents, reduce the patients＇ mechanical ventilation and shorten the days of stay in ICU.