PiCCO为导向的液体复苏策略在创伤性休克急性期中的应用

Transpulmonary thermodilution technique in application of traumatic shock

目的评价脉波指示剂连续心排血量监测(pulse contour cardiac output,Pi CCO)在创伤性休克患者救治中的应用价值。方法连续纳入2012年12月至2014年4月的101例成年创伤性休克患者,并随机分组。观察组(n=50)采用Pi CCO导向的液体复苏策略,对照组(n=51)采用传统的复苏方法。观察组液体复苏的目标按顺序为胸内血容量指数>800ml/m^2,血管外肺水指数≤10ml/kg,心脏指数>3.5L/(min·m^2)。对照组液体复苏目标为维持平均动脉压在55~65mm Hg。比较两组患者开始液体复苏前和开始后0.5、1、2、4小时的血红蛋白含量、动脉血p H值和氧分压、乳酸水平、凝血功能,4小时后输液量、失血量、输血量、尿量,7天内急性肾衰竭、弥散性血管内凝血的发生率及死亡率。结果观察组患者液体复苏后4小时内的动脉氧分压、血红蛋白含量和p H值及尿量高于对照组(P<0.05),乳酸水平和输液量低于对照组(P<0.05),凝血功能指标优于对照组(P<0.05)。7天内急性肾衰竭、弥散性血管内凝血的发生率及死亡率均低于对照组(P<0.05)。4小时后失血量和输血量两组差异均无显著性(P>0.05)。结论 Pi CCO用于指导创伤性休克患者的液体复苏效果良好,可降低患者7天病死率和并发症的发生率。

Objective To explore the effect of pulse contour cardiac output（PiCCO） in treatment of traumatic shock. Method Between December 2012 and April 2014, 101 patients with traumatic shock were divided into conventional liquid resuscitation group （control group,n=51） and PiCCO guided liquid resuscitation group （study group, n=51）. Result The levels of oxygen partial pressure, pH value and urine volume in study group were significantly higher than those in control group （P〈0.05）, while levels of hemoglobin concentration, serum lactic acid and infusion quantity were significantly lower than those in control group （P〈0.05）, and indicators of blood coagulation function were superior （P〈0.05）. The incidence of acute renal failure, diffuse intravascular coagulation and mortality rates are lower than the control group （P〈0.05）. Conclusion The PiCCO guided fluid resuscitation in treatment of patients with traumatic shock with superior effect reduced the rates of incidence of complications and mortality in seven days.