心肺联合超声与PiCCO监测指导中重度ARDS患者液体管理作用的对比研究

Comparison of cardiopulmonary ultrasound and PiCCO monitoring in guiding fluid management in patients with moderate and severe ARDS

目的比较PiCCO与心肺联合超声监测指导中重度急性呼吸窘迫综合征(ARDS)患者液体管理的作用。方法本研究为完全随机设计。选取海南省中医院2021年1月至2022年1月间收治的中重度ARDS患者90例,按照随机数字表法分为2组,对照组45例患者根据PiCCO监测进行液体管理,观察组45例患者采用心肺联合超声检查指导液体管理。比较2组心肺功能、血流动力学、液体复苏指标、机械通气时间、ICU住院时间、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、预后评价情况。结果与干预前比较,2组患者干预后的心功能指标心率下降,心指数、心功能指数升高;肺功能指标血管外肺水指数、肺血管阻力指数、肺血管通透性指数均下降;血流动力学指标全身血管阻力指数升高,中心静脉压、有创平均动脉压降低;且观察组各指标改善情况均优于对照组,差异均有统计学意义(均P<0.05)。观察组患者24 h液体入量、第3天乳酸水平、多巴酚丁胺和去甲肾上腺素用量、机械通气时间、ICU住院时间、干预后APACHEⅡ评分均低于对照组,尿量和生存率均高于对照组,差异均有统计学意义(均P<0.05)。结论心肺联合超声较PiCCO对中重度ARDS患者液体管理有较好应用效果,可以改善患者心肺功能、血流动力学等指标,促进患者康复。

Objective To compare the effects of PiCCO and cardiopulmonary combined ultrasound monitoring in guiding fluid management in patients with moderate and severe acute respiratory distress syndrome(ARDS).Methods This was a completely randomized study.A total of 90 patients with moderate and severe ARDS treated in Hainan Hospital of Traditional Chinese Medicine from January 2021 to January 2022 were selected.The patients were randomly divided into two groups according to the random number table:the control group(45 patients)received liquid management according to PiCCO monitoring,and the observation group(45 patients)received liquid management according to cardiopulmonary combined ultrasound.The cardiopulmonary function,hemodynamic indexes,fluid resuscitation indexes,mechanical ventilation time,ICU stay duration,aute phlysiology and chronic health evaluationⅡ(APACHEⅡ)Score,and prognosis evaluation were compared between the two groups.Results Compared with the indicators before intervention,after intervention,the heart rate of the patients in the two groups decreased,and the cardiac index and cardiac function index increased;pulmonary function indexes including extravascular lung water index,pulmonary vascular resistance index,and pulmonary vascular permeability index all decreased;for hemodynamic indexes,systemic vascular resistance index increased,central venous pressure and invasive mean arterial pressure decreased.The improvement of each index in the observation group was higher than that in the control group,with significant difference(P<0.05).Compared with the control group,in the observation group,the fluid intake at 24 h,the LAC level on the 3rd day,the dosage of dobutamine and norepinephrine,the mechanical ventilation time,ICU stay duration,and APACHEⅡscore after intervention were all significantly lower(P<0.05),and the urine output and survival rate of patients were significantly higher(P<0.05).Conclusions Compared with PiCCO,cardiopulmonary combined ultrasound has a better effect on fluid management in patients with moderate and severe ARDS.It can significantly improve patients′cardiopulmonary function,improve their hemodynamics,and promote patients′rehabilitation.