脉搏指示连续心排血量监测在感染性休克患者抢救中的应用效果

Application of pulse indicating continuous cardiac output in the rescue of patients with septic shock.

目的观察脉搏指示连续心排血量(PICCO)监测在感染性休克患者抢救中的应用效果。方法前瞻性选取2016年1月至2020年1月宿州市皖北煤电集团总医院收治的80例感染性休克患者为观察对象。采用随机数字表法将80例患者分为研究组与对照组,对照组(n=40)予以常规液体管理治疗,研究组(n=40)给予PICCO监测,并依据血流动力学结果对液体滴注速度、类型等调整,在必要时可予以脱水干预。观察比较2组患者治疗前、治疗1周后的血氧饱和度(SPO 2)、心率(HR)、尿量、血压(收缩压、舒张压)、乳酸、血气指标[氧合指数(PaO 2/FiO 2)、动脉血二氧化碳分压(PaCO 2)]变化。结果治疗前,2组患者的SPO 2、心率、尿量、收缩压、舒张压、乳酸水平比较,差异均无统计学意义(P>0.05);治疗1周后,研究组患者的心率[(89.66±16.75)次/min]及乳酸水平[(2.21±0.54)mmol/L]均明显低于对照组[(107.44±17.47)次/min,(3.59±2.10)mmol/L],差异均有统计学意义(P<0.05);研究组的尿量[(137.44±50.27)mL/h]、收缩压[(129.34±14.36)mmHg]、舒张压[(97.47±4.47)mmHg]及SPO 2[(0.99±0.05)%]均明显高于对照组[(120.37±29.36)mL/h,(114.56±13.64)mmHg,(84.32±5.30)mmHg,(0.76±0.02)%],差异均有统计学意义(P<0.05);研究组患者的PaO 2/FiO 2[(224.23±21.36)%]与PaCO 2[(37.57±10.07)mmHg]均明显高于对照组[(187.57±20.14)%,(17.89±9.42)mmHg],差异均有统计学意义(P<0.05)。结论与单纯常规液体管理治疗相比,感染性休克患者在常规液体管理治疗基础上在PICCO监测指导下展开救治,可更有效降低患者的心率和乳酸水平,提高血压和尿量,改善患者血气指标,效果显著。

Objective To observe the effect of pulse indicating continuous cardiac output(PICCO)monitoring in the rescue of patients with septic shock.Methods Eighty patients with septic shock admitted to the General Hospital of Suzhou Wanbei Coal Power Group from January 2016 to January 2020 were prospectively selected as observation objects.They were divided into the study group and the control group according to the random number table method.The control group(n=40)received routine fluid management treatment,and the study group(n=40)received PICCO monitoring based on hemodynamics,and adjusted the speed and type of liquid dripping according to the results of hemodynamic results,and dehydration intervention could be given when necessary.The pulse oxygen saturation(SPO 2),heart rate,urine output,blood pressure(systolic blood pressure,diastolic blood pressure),lactic acid,blood gas indicators[oxygenation index(PaO 2/FiO 2),arterial partial pressure of carbon dioxide(PaCO 2)]before treatment,after 1 week of treatment were observed and compared between the two groups.Results Before treatment,there was no statistically significant difference in SPO 2,heart rate,urine output,systolic blood pressure,diastolic blood pressure,and lactic acid levels between the two groups(P>0.05).After 1 week of treatment,the heart rate[(89.66±16.75)times/min]and lactic acid level[(2.21±0.54)mmol/L]of the study group were significantly lower than those of the control group[(107.44±17.47)times/min,(3.59±2.10)mmol/L],the differences were statistically significant(P<0.05);the urine volume of the study group[(137.44±50.27)mL/h],systolic blood pressure[(129.34±14.36)mmHg],diastolic blood pressure[(97.47±4.47)mmHg]and SPO 2[(0.99±0.05)%]were significantly higher than those of the control group[(120.37±29.36)mL/h,(114.56±13.64)mmHg,(84.32±5.30)mmHg,(0.76±0.02)%],the differences were statistically significant(P<0.05);PaO 2/FiO 2[(224.23±21.36)%]and PaCO 2[(37.57±10.07)mmHg]of the study group were significantly higher than those of the control group[(187.57±20.14)%,(17.89±9.42)mmHg],the difference was statistically significant(P<0.05).Conclusion Compared with conventional fluid management treatment alone,patients with septic shock can be treated under the guidance of PICCO monitoring based on conventional fluid management treatment,which can more effectively reduce the patient's heart rate and lactic acid level,increase blood pressure and urine output,and improve patient blood gas indicators,the effect is remarkable.