PiCCO指导下连续性血液净化治疗重症脓毒症合并应激性心肌病的临床效果分析

Clinical effect of continuous blood purification under the guidance of PiCCO in the treatment of severe sepsis complicated with stress cardiomyopathy

目的:分析脉搏指示连续心排血量监测(PiCCO)指导下连续性血液净化(CBP)治疗重症脓毒症合并应激性心肌病的临床效果。方法:选取深圳市宝安区石岩人民医院ICU收治的脓毒性心肌病患者共90例,将入选患者按照随机数字表法分为对照组(常规治疗)、PiCCO组(常规治疗+PiCCO监测)、CBP组(常规治疗+PiCCO监测+CBP治疗)3组,每组30例。比较3组患者的心肺功能、血流动力学指标、预后指标。结果:治疗48 h后,CBP组患者心脏指数(CI)、全心射血分数(GEF)、氧合指数(PaO2/FiO2)高于PiCCO组和对照组(P<0.05),而全心舒张末期容积指数(GEDVI)、血管外肺水指数(EVLWI)低于PiCCO组和对照组(P<0.05);血流动力学指标:肺血管阻力指数(PVRI)、外周血管阻力指数(SVRI)、中心静脉压(CVP)低于PiCCO组和对照组(P<0.05),平均动脉压(MAP)高于PiCCO组和对照组(P<0.05)。CBP组患者ICU住院时间与28 d病死率均低于PiCCO组和对照组(P<0.05)。结论:PiCCO指导下连续性血液净化治疗,能有效稳定重症脓毒症合并应激性心肌病患者血流动力学指标,改善心肺功能,缩短ICU治疗时间,降低死亡率。

Objective:To analyze the clinical effect of continuous blood purification(CBP)under the guidance of pulse indication continuous cardiac output monitoring(PiCCO)in the treatment of severe sepsis complicated with stress cardiomyopathy.Methods:A total of 90 patients with septic cardiomyopathy admitted to the ICU of Shiyan People’s Hospital of Bao’an District,Shenzhen were enrolled,and the selected patients were divided into three groups:control group(conventional treatment group),PiCCO group(conventional treatment+PiCCO monitoring group),and CBP group(conventional treatment+PiCCO monitoring+CBP treatment group),with 30 cases in each group.The cardiopulmonary function,hemodynamic indicators,and prognostic indicators of patients in the three groups were compared.Results:After 48 h of treatment,the cardiac index(CI),global ejection fraction(GEF)and oxygenation index(PaO2/FiO2)of patients in the CBP group were higher than those in the PiCCO group and the control group(P<0.05).The global end-diastolic volume index(GEDVI)and extravascular lung water index(EVLWI)were lower than those in the PiCCO group and the control group(P<0.05).Hemodynamic indicators:the pulmonary vascular resistance index(PVRI),systemic vascular resistance index(SVRI)and central venous pressure(CVP)were lower than those in the PiCCO group and the control group(P<0.05),and the mean arterial pressure(MAP)was higher than that in the PiCCO group and the control group(P<0.05).The length of ICU stay and 28-day mortality in the CBP group were lower than those in the PiCCO group and the control group(P<0.05).Conclusion:CBP therapy under the guidance of PiCCO can effectively stabilize hemodynamic indicators in patients with severe sepsis complicated with stress cardiomyopathy,improve cardiopulmonary function,shorten ICU treatment time,and reduce mortality.