应用PICCO监测脓毒症休克患者不同时间达复苏目标对预后的影响

Application of PICCO to monitor the impact of different time points to achieve resuscitation goal on prognosis of septic shock patients

目的 探讨应用脉搏指示连续心排血量(pulse indicates continuous cardiac output, PICCO)监测脓毒症休克患者不同时间达复苏目标对预后的影响。方法 选取重症监护病房(intensive care unit, ICU)治疗的脓毒症休克患者56例作为研究对象,根据胸腔内血容量指数(intrathoracic blood volume index, ITBVI)达到850~1 000 mL/m~2的时间不同分为早期达标组(0~6 h)31例和晚期达标组(7~12 h)25例。记录2组患者0 h、6 h、12 h、24 h、48 h的氧合指数、乳酸、感染相关的器官衰竭评分(sequential organ failure assessment, SOFA)、肝肾功能指标[总胆红素(total bilirubin, TBil)、丙氨酸转氨酶(alanine aminotransferase, ALT)、天冬氨酸转氨酶(aspartate aminotransferase, AST)、血肌酐(serum creatinine, SCr)],并比较2组患者ICU住院时间、机械通气时间、7 d及28 d病死率。结果 2组氧合指数组间、时点间、组间·时点间交互作用差异无统计学意义(P>0.05)。2组乳酸浓度均呈逐渐降低趋势,早期达标组乳酸浓度显著低于晚期达标组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。2组SOFA评分均呈逐渐降低趋势,早期达标组乳酸浓度显著低于晚期达标组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。2组SCr、ALT、AST、TBIL水平呈逐渐降低趋势,早期达标组乳酸浓度显著高于晚期达标组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。2组ICU住院时间、机械通气时间、7 d病死率差异无统计学意义(P>0.05);早期达标组28 d病死率明显低于晚期达标组,差异有统计学意义(P<0.05)。结论 在PICCO监测指导下对脓毒症休克患者实施液体复苏治疗,早期达标与晚期达标均可改善患者预后,但早期达标组较晚期达标组可明显降低SOFA评分,减少28 d病死率。

Objective To explore the application of pulse indicator continuous cardiac output(PICCO)to monitor the impact of different time points to achieve resuscitation goals on the prognosis of septic shock patients.Methods In total,56 patients with septic shock treated in the intensive care unit(ICU)were selected as the research subjects.According to the time points when the intrathoracic blood volume index(ITBVI)reached 850-1000 mL/m 2,they were divided into the early standard reaching group(0-6 h,n=31)and the late standard reaching group(7-12 h,n=25).Oxygenation index,lactate,infection-related sequential organ failure assessment(SOFA),liver and kidney function indicators[total bilirubin(TBil),alanine aminotransferase(ALT),aspartate aminotransferase(AST),and serum creatinine(SCr)]of two groups at 0 h,6 h,12 h,24 h,and 48 h,and the length ofICU stay,mechanical ventilation time,and 7-day and 28-d aymortality rate in the two groups were compared.Results There was no statistically significant difference in the interaction between groups,time points,and time points between groups with respect to the oxygenation index between the two groups(P>0.05).The lactate concentration in both groups showed a gradually decreasing trend,and the lactate concentration in the early standard reaching group was significantly lower than that in the late standard reaching group;there were statistically significant differences in the interaction between groups,time points,and time points between groups(P<0.05).The SOFA scores of both groups showed a gradually decreasing trend,and the lactate concentration in the early standard reaching group was significantly lower than that in the late standard reaching group;there were statistically significant differences in the interaction between groups,time points,and time points between groups(P<0.05).The levels of SCr,ALT,AST,and TBIL in two groups showed a gradually decreasing trend,and the lactate concentration in the early standard reaching group was significantly higher than that in the late standard reaching group;the differences in interaction between groups,time points,and time points between groups were statistically significant(P<0.05).There was no significant difference in length of ICU stay,mechanical ventilation time,and 7-day mortality rate between the two groups(P>0.05),while the 28-day mortality rate of the early standard reaching group was significantly lower than that of the late standard reaching group;the difference was statistically significant(P<0.05).Conclusion Under the guidance of PICCO monitoring,implementing fluid resuscitation treatment for septic shock patients can improve patient prognosis in both early and late standard reaching groups.However,the early standard reaching group can significantly decrease SOFA scores and reduce 28-day mortality rate compared with the late standard reaching group.