两种方式监测下液体复苏治疗脓毒症合并急性呼吸窘迫综合征的临床效果比较

Clinical efficacy of fluid resuscitation using two monitoring approaches for sepsis complicated with acute respiratory distress syndrome:a comparative study

目的比较在脉搏指示连续心排血量(Pi CCO)监测下与在中心静脉压(CVP)监测下进行液体复苏治疗脓毒症合并急性呼吸窘迫综合征(ARDS)的效果。方法将48例脓毒症合并ARDS患者随机分为Pi CCO组和CVP组,每组24例。两组均给予常规治疗,Pi CCO组、CVP组分别在Pi CCO、CVP监测下进行液体复苏。比较两组患者24 h补液量,使用血管活性药物、机械通气、连续性肾脏替代治疗(CRRT)、使用抗生素、ICU留治时间,输血情况,治疗前后呼吸频率、氧合指数、血清乳酸、血清肌酐水平,以及全因死亡及归因死亡情况。结果与CVP组比较,Pi CCO组患者24 h补液量更少,使用血管活性药物、机械通气、CRRT、使用抗生素、ICU停留治时间更短,输血比例更低(均P <0. 05)。治疗后,两组患者的呼吸频率、氧合指数及肌酐水平均较前改善,并且Pi CCO组患者的氧合指数高于CVP组,其他指标均低于CVP组(均P <0. 05)。两组的全因死亡率比较,差异无统计学意义(P> 0. 05),Pi CCO组的归因死亡率低于CVP组(P <0. 05)。结论与CVP比较,在Pi CCO监测下对脓毒症合并ARDS患者进行液体复苏,能缩短治疗时间,更有效地改善肺功能和代谢水平,降低患者的归因死亡风险。

Objective To compare the efficacy of fluid resuscitation for sepsis complicated with acute respiratory distress syndrome(ARDS)between pulse indicator continuous cardiac output(PiCCO)monitoring and central venous pressure(CVP)monitoring.Methods Forty-eight sepsis patients complicated with ARDS were randomly divided into PiCCO group and CVP group,with 24 cases in each group.Both groups were given conventional treatment,the PiCCO group and the CVP group underwent fluid resuscitation under PiCCO and CVP monitoring,respectively.The indices of the patients were compared between the two groups,including the amount of 24-hour rehydration volume,use of vasoactive substances,mechanical ventilation,continuous renal replacement therapy(CRRT),antibiotics use,ICU stay,blood transfusion,and respiratory rate,oxygenation index,serum lactic acid and serum creatinine levels before and after treatment,as well as all-cause mortality and attribution mortality.Results Compared with the CVP group,the PiCCO group had less amount of 24-hour rehydration,shorter durations of vasoactive substances use,mechanical ventilation,CRRT and antibiotics use,shorter ICU stay,and lower proportion of blood transfusion cases(all P<0.05).After treatment,the levels of respiratory rate,oxygenation index,and creatinine were improved in both groups compared with the previous levels,and the oxygenation index was higher and other indices were lower in the PiCCO group than those in the CVP group(all P<0.05).There was no statistically significant difference in the all-cause mortality between the two groups(P>0.05),the attribution mortality in the PiCCO group was lower than that in the CVP group(P<0.05).Conclusion Compared with CVP monitoring,fluid resuscitation under PiCCO monitoring can shorten treatment duration,improve lung function and metabolism levels more effectively,and reduce the attribution risk for the death in the sepsis patients complicated with ARDS.