PiCCO监测对烧伤机械通气患者休克期补液的临床指导意义

Clinical significance of pulse indicator continuous cardiac output in monitoring fluid resuscitation for burned patients during mechanical ventilation

目的:探讨采用脉搏指示连续心排血量(PiCCO)监测血流动力学参数对烧伤机械通气患者休克期液体复苏的临床指导意义。方法:收集2014年1月—2019年5月郑州市第一人民医院烧伤科ICU收治的68例大面积烧伤后气管切开患者的PiCCO监测数据。根据患者是否进行机械通气治疗将患者分为机械通气组和非机械通气组,观察两组患者不同时间点血流动力学指标和血气指标的变化。结果:心排血指数在伤后24 h下降至最低,随后逐渐升高并恢复至正常范围。胸腔内总血容量指数在伤后36 h升至最高,随后逐渐降低,至伤后96 h左右恢复至正常范围。血管外肺水指数在伤后12~24 h一直处于高水平,24 h后逐渐下降,至72 h下降至最低点,随后逐渐升高并恢复至正常范围。系统血管阻力指数伤后12~24 h一直处于高水平,随后逐渐下降,至72 h下降至正常范围。伤后12~36 h及72 h两组患者血乳酸水平比较差异具有统计学意义(P<0.05),机械通气组患者血乳酸水平低于非机械通气组;伤后12~72 h两组患者氧合指数的差异具有统计学意义(P<0.05),机械通气组患者氧合指数水平高于非机械通气组。两组患者不同时间点PiCCO监测指标比较,机械通气组心排血指数伤后24、36、48和72 h明显高于非机械通气组(P<0.05),胸腔内总血容量指数伤后36、48和72 h明显低于非机械通气组(P<0.05),血管外肺水指数在伤后12、36、48、72 h均明显低于非机械通气组(P<0.05),系统血管阻力指数伤后36、48和72 h明显低于非机械通气组(P<0.05)。结论:PiCCO监测在烧伤机械通气休克期液体复苏过程中,能够准确、敏感显示患者血流动力学变化,具有重要的临床指导意义。

Objective:To investigate the clinical guiding significance of pulse indicator continuous cardiac output(PiCCO)in monitoring hemodynamic parameters to fluid resuscitation during the shock stage of burn patients with mechanical ventilation.Methods:The PiCCO monitoring data were collected of 68 burned patients with tracheotomy in burn ICU of Zhengzhou First people’s Hospital from Jan.2014 to May 2019.Patients were divided into mechanical ventilation group and non-mechanical ventilation group according to whether they received mechanical ventilation.The changes of hemodynamic parameters and blood gas analysis index in different time points after mechanical ventilation were observed in the two groups.Results:The cardiac output index of burn patients decreased to the lowest 24 hours after burn,then gradually increased and returned to normal range.The total blood volume index in thoracic cavity increased to the maximum 36 hours after injury,then decreased gradually and returned to normal range at 96 hours.The extravasular lung water index remained at a high level from 12 to 24 hours after injury,then decreased gradually after 24 hours,reached the lowest point at 72 hours,and then gradually increased and returned to the normal range.The systemic vascular resistance index remained at a high level from 12 to 24 hours after injury,and then gradually decreased to normal range at 72 hours.From 12 to 36 hours and 72 hours afte r injury,the blood lactic acid levels of the patients in the two groups were statistically different(P<0.05),and the blood lactic acid level was lower in patients with mechanical ventilation than those without mechanical ventilation.The oxygenation indexes of the patients in the two groups were statistically different(P<0.05)from 12 to 72 hours after injury,and it was higher in patients with mechanical ventilation than those without mechanical ventilation.Comparing the PiCCO monitoring indicators between the two groups at different time points,the cardiac output index was obviously hi gher at 24,36,48 and 72 hours after injury in the patients with mechanical ventilation than those without mechanical ventilation(P<0.05),the total intrathoracic blood volume index was markedly lower at 36,48 and 72 hours after injury,the extravascular lung water index was obviously lower at 12,36,48 and 72 hours after injury,and the systemic vascular resistance index was significantly lower at 36,48 and 72 hours after injury in the patients with mechanical ventilation than those without mechanical ventilation(P<0.05).Conclusions:For burned patients with mechanical ventilation during fluid resuscitation in the shock stage,PiCCO monitoring can show the hemodynamic changes accurately and sens itively,and so has important clinical significance.