PICCO指导液体复苏用于重症肺炎伴感染性休克患者的临床效果

Clinical effect of PICCO guiding fluid resuscitation in patients with severe pneumonia complicated with septic shock

目的:探讨脉搏指示连续心排血量(PICCO)指导液体复苏用于重症肺炎伴感染性休克患者的临床效果。方法:按照治疗方法不同将107例重症肺炎伴感染性休克患者分为观察组(n=54)与对照组(n=53)。观察组通过PICCO指导液体复苏;对照组按常规观察中心静脉压、平均动脉压、混合静脉血氧饱和度等指标进行液体复苏。比较两组患者心率与血压、氧合指数、液体输注量与正平衡量、血清炎性与心肌损伤指标及临床结局。结果:两组患者复苏6、12、24 h时,心率(HR)、平均动脉压(MAP)、氧合指数水平比较,差异无统计学意义(P>0.05);两组患者复苏6 h时,液体输注量、液体正平衡量比较,差异无统计学意义(P>0.05),观察组患者复苏12、24 h时液体输注量、液体正平衡量少于对照组(P<0.05);观察组患者复苏24 h时,血清炎性指标白细胞介素6(IL-6)、IL-1β、肿瘤坏死因子α(TNF-α)、磷酸肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白T(cTnT)、脑钠肽(BNP)水平均低于对照组(P<0.05);观察组患者复苏6 h时乳酸清除率高于对照组(P<0.05),复苏24 h时复苏达标率高于对照组(P<0.05);两组患者机械通气时间、住ICU时间及28 d病死率比较,差异无统计学意义(P>0.05)。结论:重症肺炎伴感染性休克患者PICCO指导液体复苏可改善机体血流动力学及呼吸循环功能,相较于常规目标导向指导可加快乳酸清除,提高复苏达标率,减少累计液体输注量,减轻炎性反应与心肌损伤。

Objective:To investigate the clinical effect of pulse indicator continuous cardiac output(PICCO)guided fluid resuscitation in patients with severe pneumonia and septic shock.Methods:A total of 107 patients with severe pneumonia and septic shock were divided into observation group(n=54)and control group(n=53)according to different treatment methods.The observation group was guided by PICCO for fluid resuscitation,while the control group was guided by conventional observation of central venous pressure,mean arterial pressure,mixed venous oxygen saturation and other indicators for fluid resuscitation.The heart rate and blood pressure,oxygenation index,fluid infusion volume and positive balance volume,serum inflammatory and myocardial injury indicators and clinical outcomes were compared between the two groups.Results:There was no significant difference in heart rate(HR),mean arterial pressure(MAP)and oxygenation index between the two groups at 6,12 and 24 h after resuscitation(P>0.05).At 6 h of resuscitation,there was no significant difference in the amount of fluid infusion and positive fluid balance between the two groups(P>0.05).The amount of fluid infusion and positive fluid balance at 12 and 24 h after resuscitation in the observation group were less than those in the control group(P<0.05).The levels of serum inflammatory indexes interleukin-6(IL-6),interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α),creatine kinase isoenzyme(CK-MB),cardiac troponin T(cTnT)and brain natriuretic peptide(BNP)in the observation group were lower than those in the control group at 24 h after resuscitation(P<0.05).The lactate clearance rate at 6 h of resuscitation in the two groups was higher than that in the control group,and the recovery rate at 24 h of resuscitation was higher than that in the control group(P<0.05).There was no significant difference in mechanical ventilation time,ICU time and 28-day mortality between the two groups(P>0.05).Conclusion:PICCO-guided fluid resuscitation in patients with severe pneumonia and septic shock can improve hemodynamics and respiratory circulation.Compared with conventional goal-directed guidance,PICCO-guided fluid resuscitation can accelerate lactate clearance,improve resuscitation compliance rate,reduce cumulative fluid infusion,and reduce inflammatory response and myocardial injury.