PiCCO指导脓毒症心肌抑制患者液体复苏的临床研究

Clinical study of liquid resuscitation in sepsis patients with myocardial inhibition guided by PiCCO

目的探讨PiCCO指导脓毒症心肌抑制患者液体复苏的效果。方法选取2016年12月~2017年12月入住惠州市中心医院重症医学科的脓毒症患者100例,根据PICCO监测的GEF分为心肌抑制组(56例)和正常组(44例),3h内给予30mL/kg的积极液体复苏,比较两组患者液体复苏后血流动力学参数的变化。结果 (1)治疗前,两组患者MAP、HR、CVP、CI、EVLWI及GEDVI差异无统计学意义(P>0.05);心肌抑制患者SVI、GEF、LVSWI及dPmx均较正常组患者降低,差异有统计学意义(P<0.05)。(2)经液体复苏后,两组患者的液体输注量差异无统计学意义(P>0.05);两组患者MAP、HR、CVP及CI均较治疗前有所改善,两组患者治疗后差异无统计学意义(P>0.05);治疗后心肌抑制组患者EVLWI和GEDVI均显著高于正常值患者,差异有统计学意义(P<0.05);治疗后心肌抑制患者SVI、GEF、LVSWI及d Pmx仍然较正常组患者降低,差异有统计学意义(P<0.05)。结论脓毒症心肌抑制患者需要更少的液体输注量,可以根据GEDVI的变化值来指导脓毒症患者如何实施液体复苏治疗,保证足够的液体参与血液循环,并且血管外肺水合适,从而明显改善患者的临床状况及预后。

Objective To study the effect of PiCCO on liquid resuscitation sepsis patients with myocardial inhibition.Methods From December 2016 to December 2017,100 patients with sepsis treated in Huizhou Center Hospital Intensive Medicine Department were divided into myocardial suppression group(56 cases)and normal group(44 cases)according to PICCO monitoring.3h was given positive fluid resuscitation in 30mL/kg,and hemodynamic parameters were compared between the two groups after fluid resuscitation.Results(1)There was no significant difference in MAP,HR,CVP,CI,EVLWI and GEDVI between the two groups before treatment(P>0.05);The SVI,GEF,LVSWI and dPmx in patients with myocardial suppression were lower than those in the normal group(P<0.05).(2)After liquid resuscitation,there was no significant difference in the amount of liquid transfusion between the two groups(P>0.05).The MAP,HR,CVP and CI of the two groups were improved compared with that before treatment,and there was no significant difference between the two groups after treatment(P>0.05).The EVLWI and GEDVI in patients with myocardial suppression after treatment were significantly higher than those in normal patients(P<0.05).After treatment,the levels of SVI,GEF,LVSWI and dPmx in patients with myocardial suppression were still lower than those in patients with normal control(P<0.05).Conclusion Patients with septic myocardial inhibition require less fluid infusion,which can be used to guide the treatment of fluid resuscitation in patients with sepsis according to the changes in GEDVI,to ensure that sufficient fluid is involved in the circulation of blood,and that the extravascular lung water is appropriate,thus significantly improving the patient's clinical status and prognosis.