脓毒症患者应用PiCCO与CVP指导早期液体复苏治疗的临床价值

Clinical Value of PiCCO and CVP in Guiding Early Fluid Resuscitation in Patients with Sepsis

目的:比较脓毒症患者应用脉搏指示持续心排出量(PiCCO)与中心静脉压(CVP)指导早期液体复苏治疗的临床价值。方法:回顾性分析2020年1月-2021年1月于笔者所在医院收治的60例脓毒症患者的临床资料,根据早期液体复苏指导方式的不同将其分为对照组和试验组,每组30例。对照组采用CVP指导早期液体复苏治疗,试验组采用PiCCO指导早期液体复苏治疗。比较两组治疗2 d后血压波动幅度、血清脑钠肽(BNP)、尿量、平均动脉压(MAP)及中心静脉血氧饱和度(ScvO_2)。比较两组治疗6、12及24 h复苏目标达标率及预后情况。结果:治疗2 d后,试验组血压波动幅度及BNP水平均明显低于对照组,差异有统计学意义(P<0.05);治疗2 d后,试验组尿量、MAP及ScvO_2均明显高于对照组,差异有统计学意义(P<0.05)。治疗6、12及24 h,试验组液体复苏治疗达标率明显高于对照组,差异有统计学意义(P<0.05)。液体复苏治疗后1周,试验组预后良好率明显高于对照组,差异有统计学意义(P<0.05)。两组死亡率比较差异无统计学意义(P>0.05)。结论:PiCCO指导早期液体复苏治疗较CVP指导能更有效地恢复患者循环血容量,改善血流动力学,且患者预后更好。

Objective:To compare the clinical value of continuous cardiac output(PiCCO)and central venous pressure(CVP)in guiding early fluid resuscitation treatment in patients with sepsis.Method:The clinical data of 60 patients with sepsis admitted in our hospital from January 2020 to January 2021 were retrospectively analyzed.According to the different guidance methods of early fluid resuscitation,they were divided into the control group and the experimental group,with 30 patients in each group.The control group was treated with CVP guided early fluid resuscitation,and the experimental group was treated with PiCCO guided early fluid resuscitation.The fluctuation amplitude of blood pressure,serum brain natriuretic peptide(BNP),urine volume,mean arterial pressure(MAP)and central venous oxygen saturation(ScvO2)were compared between the two groups after 2 d of treatment.The resuscitation target achievement rate after 6,12 and 24 h treatment and prognosis of the two groups were compared.Result:After 2 d of treatment,the fluctuation amplitude of blood pressure and BNP level in the experimental group were significantly lower than those in the control group,the differences were statistically significant(P<0.05).After 2 d of treatment,the urine volume,MAP and ScvO2 in the experimental group were significantly higher than those in the control group,the differences were statistically significant(P<0.05).After 6,12 and 24 h of treatment,fluid resuscitation target achievement rate in the experimental group was significantly higher than that in the control group,and the difference was statistically significant(P<0.05).One week after fluid resuscitation treatment,the rate of good prognosis in the experimental group was significantly higher than that in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in mortality between the two groups(P>0.05).Conclusion:PiCCO guided early fluid resuscitation treatment is more effective than CVP guided treatment in restoring circulating blood volume,improving hemodynamics,and patients’prognosis is better.