重症肺炎患者中无创心排量监测的临床意义

Clinical Significance of Noninvasive Cardiac Output Monitoring in Patients with Severe Pneumonia

目的 观察无创心排量监测(NICOM)在重症肺炎患者中的治疗效果,为NICOM在重症肺炎患者补液治疗中的应用提供依据。方法 收集2016年10月至2017年1月我科收治的73例重症肺炎患者,其中35例患者应用NICOM进行心排量测定,为监测组,另外38例患者未应用NICOM,为对照组,所有患者均给予重症肺炎常规治疗。对监测组与对照组间48h急性生理与慢性健康评分Ⅱ(APACHEⅡ评分)、48h乳酸值、48h降钙素原(PCT)值、48h补液量、48h血管活性药物用量、应用呼吸机时间、ICU住院时间以及28d病死率等情况进行比较分析。结果 监测组48h补液量、48h APACHEⅡ评分、48h乳酸值均低于对照组(均P<0.05)。监测组与对照组比较,应用呼吸机时间和ICU住院时间较短、28d病死率低(均P<0.05),48 h升压药(去甲肾上腺素)用量和PCT值无明显差异(均P>0.05)。结论 NICOM用于重症肺炎患者血流动力学监测,能够指导补液治疗,缩短住院时间,改善预后。

Objective To investigate the therapeutic effect of noninvasive cardiac output monitoring(NICOM)and demonstrate its utility and application in patients with severe pneumonia.Methods We retrospectively analyzed 73 patients with severe pneumonia admitted to our department between October 2016 and January 2017.Based on a standard treatment regimen for severe pneumonia,cardiac output was measured using NICOM in 35 patients(monitoring group),and 38 patients did not receive cardiac output monitoring(control group).Intergroup comparisons were performed to study the acute physiology and chronic health evaluation scoreⅡ(APACHEⅡ),blood lactate,and procalcitonin(PCT)levels after 48 h,fluid volume and vasoactive drug dosage within 48 h,the duration of mechanical ventilation and intensive care unit stay,as well as the 28-day mortality.Results The fluid volume within 48 h,as well as the APACHEⅡscore and blood lactate levels after 48 h were lower in the monitoring than in the control group(all P<0.05).The ventilator and ICU hospitalization time were shorter,and the 28-day mortality was lower in the monitoring than in the control group(all P<0.05).No significant intergroup difference was observed in the amount of pressor agent(norepinephrine)used within 48 h and the PCT values(all P>0.05).Conclusion NICOM can aid in hemodynamic monitoring,guide treatment,shorten hospitalization time,and improve prognosis in patients with severe pneumonia.