PICCO监测严重创伤并发毛细血管渗漏综合征患者血流动力学变化的意义研究

Significance of PICCO Monitoring Hemodynamic Changes in Patients with Severe Trauma Complicated with Capillary Leak Syndrome

目的:研究PICCO监测严重创伤并发毛细血管渗漏综合征(CLS)患者血流动力学变化的意义。方法:采用脉搏指示连续心排量(PICCO)监测技术监测本院2018年1月-2019年12月收治62例严重创伤后并发CLS患者术后即刻、术后1、2、3、4、5 d血流动力学,包括胸内血容积指数(ITBI)、血管外肺水指数(EVLWI)及液体平衡变化,根据预后分为存活组(n=41)和死亡组(n=21),比较两组基本情况,入院时损伤严重程度(ISS评分)、肺损伤评分(Murray评分)、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ评分),术后1、2、3、4、5 d的ITBI、EVLWI变化及每日液体出入量。记录补液前后全心舒张末容积(GFDV)、每搏变异(SVV)变化。结果:死亡组的ISS、Murray、APACHEⅡ评分均明显高于存活组,差异均有统计学意义(P<0.05)。死亡组术后各时间点ITBI无明显变化,差异无统计学意义(P>0.05)。存活组术后1、2、3 d的ITBI逐渐升高,差异有统计学意义(P<0.05)。存活组术后1、2、3、4、5 d的ITBI均明显高于死亡组,差异均有统计学意义(P<0.05)。死亡组术后1、2、3、4 d的EVLWI逐渐升高,存活组术后1、2、3 d的EVLWI逐渐升高,差异均有统计学意义(P<0.05)。术后即刻、术后1、2、3、4、5 d,存活组的EVLWI均低于死亡组,差异均有统计学意义(P<0.05)。存活组补液后GFDV明显高于补液前,且高于死亡组,SVV明显低于补液前,且低于死亡组,差异均有统计学意义(P<0.05)。存活组患者术后1、2、3、4 d液体平衡呈下降趋势,术后5 d上升略有上升,差异有统计学意义(P<0.05)。死亡组术后各时间点液体平衡比较,差异无统计学意义(P>0.05)。存活组患者术后3、4、5 d液体平衡均明显低于死亡组,差异均有统计学意义(P<0.05)。结论:严重创伤后并发CLS患者术后不同时期血流动力学存在明显变化,通过对患者血流动力学的监测对判断预后和指导液体治疗具有重要的意义。

Objective:To study the significance of PICCO monitoring hemodynamic changes in patients with severe trauma complicated with capillary leak syndrome(CLS).Method:The pulse indicated continuous cardiac output(PICCO)monitoring technology was used to monitor the hemodynamics of 62 patients with CLS after severe trauma admitted to our hospital from January 2018 to December 2019 immediately after surgery,at day 1,2,3,4,and 5 after surgery,including intrathoracic blood volume index(ITBI),extravascular lung water index(EVLWI)and fluid balance.According to the prognosis,they were divided into survival group(n=41)and death group(n=21).The basic information,severity of injury(ISS score),lung injury score(Murray score),acute physiology and chronic health scoreⅡ(APACHEⅡscore),ITBI,EVLWI and daily fluid intake and output were compared between the two groups on admission.The changes of global end diastolic volume(GFDV)and stroke variation(SVV)were recorded before and after fluid infusion.Result:The ISS,Murray and APACHEⅡscores of death group were significantly higher than those of survival group,the differences were statistically significant(P<0.05).There was no significant difference in ITBI between the two groups(P>0.05).ITBI in the survival group was gradually increased on day 1,2 and 3 after surgery,the difference was statistically significant(P<0.05).The ITBI of survival group was significantly higher than that of death group at 1,2,3,4,5 days after operation,the differences were statistically significant(P<0.05).EVLWI in the death group increased gradually at 1,2,3,and 4 days after surgery,while EVLWI in the survival group increased gradually at 1,2,and 3 days after surgery,with statistically significant differences(P<0.05).EVLWI of survival group were lower than those of death group immediately after operation,1,2,3,4,5 days after operation,the differences were statistically significant(P<0.05).The GFDV of survival group was significantly higher than that before fluid infusion,and higher than that of death group,SVV was significantly lower than that before fluid infusion,and lower than that of death group,the differences were statistically significant(P<0.05).In the survival group,fluid balance decreased on day 1,2,3 and 4 after surgery,and increased slightly on day 5 after surgery,with statistically significant difference(P<0.05).There was no significant difference in fluid balance at each time point in the death group(P>0.05).The fluid balance in the survival group were significantly lower than those in the death group at 3,4 and 5 days after operation,the differences were statistically significant(P<0.05).Conclusion:There are significant changes in hemodynamics in patients with CLS after severe trauma at different periods after surgery.Monitoring the patient’s hemodynamics is of great significance to judge the prognosis and guide fluid therapy.