PICCO在老年高钠高渗性脱水患者中的应用

The Research of the Liquid Recovery in eldery patients with hypernatremia and hyperosmotic anhydration under the PICCO

目的 探讨脉波轮廓温度稀释连续心排量监测技术（pulse indicator continous cardiacoutput，PICCO）对高钠高渗性脱水患者液体管理的意义。方法 回顾性分析2012年8月至2017年6月入长沙市第四医院急诊ICU高钠高渗性脱水大于60岁老年患者76例，按使用PICCO分为观察组（使用PICCO）34例和对照组（CVP监测）42例。观察组根据每日PICCO数据进行液体管理。对照组根据心率、血压、CVP等指标进行液体管理。比较两组患者的病死率，急性肺水肿等并发症发生率、高渗纠正时间、治疗前及治疗48 h后的血钠、血浆总渗透压间差异；观察组治疗48h前后ELWI、CI、GEDI间的差异。结果 两组治疗48h后血钠及血浆总渗透压均有改善（P〈0.05），与对照组相比，观察组纠正高钠血症的时间更短（P〈0.05）；急性肺水肿发生率及病死率更低（P〈0.05）；GEDI改善更明显（P〈0.05）。结论 PICCO监测对高钠高渗性脱水液体管理过程中具有积极的临床指导意义，可有效改善患者预后，减少急性肺水肿等并发症的发生率及死亡率。

Objective To observe the value of the liquid recovery in patients with hypernatremia and hyperosmotic anhydration under the PICCO detection. Methods A total of 76 over 60 years of age with hypernatremia and hyperosmotic anhydration in emergency intensive care unit （EICU） were selected. The patients were divided into observation group and control groups according to the use of PICCO detection during the treatment, PICCO detection was used in the observation group and 34 patients were included, the routine such as heart rate,blood pressure and CVP detection was used in the control group and 42 patients were included.The mortality, the incidence of acute pulmonary edema, the correction time of hypernatremia and hyperosmotic anhydration, the blood sodium and plasma total osmotic pressure before and after 48 h treatment were compared between the two groups.The differences of ELWI, CI and GEDI before and after 48h treatment were compared in the observation group. Results The blood sodium and plasma total osmotic pressure were improved in the two groups after 48h treatment （P〈0.05）,the decrease of the observation group was more obvious than the control group,and the correction time of hypernatronemia was shorter than the control group.The incidence of acute pulmonary edema and mortality in the observation group were lower than the control group （P〈0.05）. GEDI of the observation group was significantly improved after treatment （P〈0.05）. Conclusions PICCO detection has effectively clinical significance in the management of hypernatremia and hyperosmotic anhydration. It can effectively improve the prognosis of patients, and reduce the incidence of acute pulmonary edema and mortality.