脉搏指示连续心排血量监测指标动态变化与感染性休克患者预后的关系

PICCO monitoring indexes dynamic change and the study of the relationship between the prognosis of patients with septic shock

目的研究脉搏指示连续心排血量(PICCO)监测指标的动态变化与感染性休克患者预后的关系。方法选取2015年1月至2017年10月于遵义医学院第五附属(珠海)医院ICU病房治疗的52例感染性休克患者为研究对象,所有患者均进行集束化治疗及PICCO监测,按预后分为存活组和死亡组,比较两组患者的PICCO指标1周内的动态变化,并行Logistic回归分析PICCO监测指标与预后的关系。结果 52例患者经治疗后,26例存活,26例死亡。两组患者治疗前后1周内传统指标心率、中心静脉压、平均动脉压差异均无统计学意义(均P>0.05);两组患者入院第1天PICCO各项指标差异均无统计学意义(均P>0.05);治疗后,存活组患者的心脏指数(CI)、血管外肺水指数(EVLWI)、肺毛细血管通透性指数(PVPI)随时间进展呈下降趋势,死亡组无显著变化,两组差异有统计学意义(P<0.05);两组患者体循环阻力指数、胸腔内血容积指数治疗前后变化差异均无统计学意义(均P>0.05)。Logistic回归分析显示,CI、EVLWI、PVPI是预后的危险因素。结论 PICCO指标的动态变化有助于评估感染性休克患者的治疗效果及预后,其中CI、EVLWI、PVPI与预后关系密切。

Objective To explore the relationship of dynamic change of pulse indicate continuous cardiac output （PICCO） monitor indexes with the prognosis of patients with septic shock.Methods Fifty-two patients with septic shock from January 2015 to October 2017 admitted in department of ICU in the fifth affiliated hospital of Zunyi Medical College were selected, all patients received cluster treatment and PICCO monitor, all patients were divided into survival group and death group according to the prognosis, the dynamic changes of PICCO indexes within 1 week were compared, and the relationship between PICCO monitor indexes and prognosis were analyzed by Logistic regression analysis.Results For 52 cases patients after treatment,26 cases were survival,26 cases died. Traditional indexes in two groups before and after treatment 1 week heart rate, central venous pressure and mean arterial pressure showed no significant difference （P〉0.05）;the indicators and two groups of PICCO hospital day 1 had no comparative difference （P〉0.05）; but after treatment,CI,EVLWI,PVPI of survival group declined over time, the death group changed little,the two groups had significant difference（P〈0.05）,two groups of SVRI ITBVI changes before and after the treatment no significant difference was observed （P〉0.05）. By Logistic regression analysis showed that CI, EVLWI and PVPI index were risk factors for prognosis.Conclusion PICCO index dynamic change helps to evaluate the therapeutic effect and prognosis of patients with septic shock, the relationship between prognosis and CI, EVLWI, PVPI index is closely.