脉搏指示连续心排血量监测技术指导脓毒症休克液体复苏的临床价值研究

Clinical value of pulse indicator continuous cardiac output monitoring technique in guiding fluid resuscitation of septic shock

目的探讨脉搏指示连续心排血量监测技术(PiCCO)指导脓毒症休克(SS)液体复苏的临床价值。方法按随机数字表法将2019年2月-2021年2月广东医科大学附属第二医院急诊科收治的78例SS患者分为两组,每组39例。对照组采用常规液体复苏,观察组在PiCCO指导下液体复苏。比较两组血流动力学指标、复苏液体量、血管活性药物用量、血清生化指标及并发症情况。结果观察组治疗后每搏量(SI)、中心静脉压(CVP)低于对照组,平均动脉压(MAP)高于对照组,有统计学差异(P<0.05);观察组复苏液体总量、去甲肾上腺素用量少于对照组,治疗后内皮素-1(ET-1)、白介素-10(IL-10)和并发症发生率低于对照组,有统计学差异(P<0.05)。结论PiCCO指导下液体复苏可增强SS治疗效果,纠正机体血流动力学异常,减轻炎症反应,且有助于减少液体复苏并发症,加快病情稳定。

Objective To investigate the clinical value of pulse indication continuous cardiac output monitoring(PiCCO)in fluid resuscitation of septic shock(SS).Methods 78 patients with SS admitted to the Emergency Department of the Second Affiliated Hospital of Guangdong Medical University from February 2019 to February 2021 were divided into two groups with 39 cases in each group according to random number table method.The control group received conventional liquid resuscitation,and the observation group received liquid resuscitation under the guidance of PiCCO.Hemodynamic indexes,resuscitation fluid volume,vasoactive drug dosage,serum biochemical indexes and complications were compared between the two groups.Results After treatment,stroke volume(SI)and central venous pressure(CVP)in observation group were lower than control group,and mean arterial pressure(MAP)was higher than control group,with statistical difference(P<0.05).The total amount of resuscitation fluid and dosage of norepinephrine in the observation group were less than those in the control group,and the incidence of endothelin-1(ET-1),interleukin-10(IL-10)and complications after treatment were lower than those in the control group,with statistical differences(P<0.05).Conclusion Liquid resuscitation under the guidance of PiCCO can enhance the therapeutic effect of SS,correct hemodynamic abnormalities,reduce inflammation,reduce complications of fluid resuscitation,and accelerate the stability of the disease.