脉搏指示连续心排血量监测联合重症超声导向休克治疗在休克患者液体入量管理中的应用研究

Application of pulse-indicated continuous cardiac output monitoring combined with critical care ultrasound-oriented convulsive therapy in the management of fluid intake in shock patients

目的:探讨脉搏指示连续心排血量(PICCO)监测联合重症超声导向休克治疗在休克患者液体入量管理中的应用价值。方法:选取绍兴市人民医院2017年5月至2020年5月收治的休克患者82例为观察对象,采用随机数字表法分为对照组和研究组,每组41例。对照组予PICCO监测,研究组患者予PICCO监测联合重症超声导向休克治疗。对比两组患者液体入量管理相关指标[24 h液体总入量、中心静脉压(CVP)、平均动脉压(MAP)、氧合指数及乳酸]、治疗转归相关指标[机械通气时间、ICU入住时间、24 h病情缓解率、28 d病死率、序贯器官衰竭评估(SOFA)评分]。结果:研究组24 h液体总入量[(2 516.98±254.78)mL]、乳酸[(0.60±0.05)mmol/L]均明显低于对照组[(2 920.02±295.33)mL、(1.34±0.15)mmol/L]( t=16.573、3.837, P<0.001、 P=0.041)。研究组CVP[(13.38±1.41)mmHg]、MAP[(82.34±8.22)mmHg]、氧合指数[(224.06±23.21)mmHg]均明显高于对照组[(8.53±0.85)mmHg、(70.92±7.18)mmHg、(192.30±19.70)mmHg]( t=5.152、6.754、-2.498,均 P<0.05)。研究组机械通气时间[(7.54±0.72)d]、ICU入住时间[(11.46±1.11)d]均明显短于对照组[(11.72±1.13)d、(18.29±1.73)d]( t=4.727、5.224,均 P<0.05)。研究组24 h病情缓解率[85.37%(35/41)]明显高于对照组[63.41%(26/41)],28 d病死率[7.32%(3/41)]明显低于对照组[29.27%(12/41)](χ^(2)=5.185、6.608,均 P<0.05)。研究组SOFA评分[(6.86±0.63)分]明显低于对照组[(11.05±0.91)分]( t=4.814, P<0.05)。 结论:PICCO监测联合重症超声导向休克治疗在休克患者液体入量管理中的应用效果显著,可明显减少液体总入量,明显改善患者治疗转归相关指标。

Objective To investigate the application value of pulse-indicated continuous cardiac output(PICCO)monitoring combined with critical care ultrasound-oriented convulsive therapy in the management of fluid intake in shock patients.Methods Eighty-two patients with shock who received treatment in Shaoxing People's Hospital,China between May 2017 and May 2020 were included in this study.They were randomly assigned to undergo either PICCO monitoring(control group,n=41)or PICCO monitoring combined with critical care ultrasound-oriented convulsive therapy(study group,n=41).Fluid intake management-related indexes[24-hour total fluid intake,central venous pressure,mean arterial pressure,oxygenation index and lactic acid]and treatment outcome-related indexes(mechanical ventilation time,intensive care unit length of stay,24-hour remission rate,28-day mortality rate,sequential organ failure assessment score)were compared between control and study groups.Results 24-hour total fluid intake and lactic acid level in the study group were(2516.98±254.78)mL and(0.60±0.05)mmol/L,respectively,which were significantly lower than those in the control group[(2920.02±295.33)mL,(1.34±0.15)mmol/L,t=16.573,3.837,P<0.01,P=0.041).Central venous pressure,mean arterial pressure and oxygenation index in the study group were(13.381±1.41)mmHg,(82.34±8.22)mmHg and(224.06±23.21)mmHg,respectively,which were significantly higher than those in the control group[(8.53±0.85)mmHg,(70.92±7.18)mmHg,(192.30±19.70)mmHg,t=5.152,6.754,-2.498,all P<0.05].Mechanical ventilation time and intensive care unit length of stay in the study group were(7.54±0.72)days and(11.46±1.11)days,respectively,which were significantly shorter than those in the control group[(11.72±1.13)days,(18.29±1.73)days,t=4.727,5.224,both P<0.05).24-hour remission rate in the study group was significantly higher than that in the control group[85.37%(35/41)vs.63.41%(26/41),χ^(2)=5.185,P<0.05].28-day mortality rate in the study group was significantly lower than that in the control group[7.32%(3/41)vs.29.27%(12/41),χ^(2)=6.608,P<0.05].Sequential organ failure assessment score in the study group was significantly lower than that in the control group[(6.86±0.63)points vs.(11.05±0.91)points,t=4.814,P<0.05].Conclusion PICCO monitoring combined with critical care ultrasound-oriented convulsive therapy exhibits an obvious effect in the management of fluid intake in shock patients,which can greatly reduce total fluid intake and remarkably improve treatment outcome-related indexes.