PiCCO联合快速反应体系对感染性休克液体复苏的监控效果分析

Effect of PiCCO combined with rapid response system on monitoring of fluid resuscitation of septic shock patients

目的探讨脉搏指示持续心输出量(PiCCO)联合快速反应体系对感染性休克患者液体复苏的监控效果。方法选择2018年1-6月在武汉市第一医院ICU诊断治疗的感染性休克患者60例的临床资料进行回顾性分析,2018年1-3月采用常规方法监测液体复苏效果的30例患者为对照组,2018年4-6月采用PiCCO联合快速反应体系监测液体复苏效果的30例患者为研究组。比较两组患者治疗前以及治疗3 d后血管活性药维持平均动脉压(MAP)、血管活性药物评分、血乳酸水平、尿量、APACHEⅡ评分。统计两组患者机械通气时间、血管活性药应用时间、入住ICU时间;统计两组复苏成功率、肺水肿发生率以及病死率。结果治疗后,两组患者血乳酸、血管活性药物评分、APACHEⅡ均呈下降趋势,尿量、MAP呈上升趋势(P<0.05);治疗3 d后,研究组血乳酸、血管活性药物评分、APACHEⅡ显著低于对照组,尿量、MAP高于对照组(P<0.05);研究组机械通气时间、血管活性药物治疗时间、ICU入住时间显著短于对照组(P<0.05);研究组复苏成功率显著高于对照组,肺水肿显著低于对照组(P<0.05)。结论感染性休克患者采用PiCCO联合快速反应体系监控液体复苏效果,能显著改善临床指标,提高抢救成功率,降低肺水肿。

OBJECTIVE To explore the effect of pulse indication continuous cardiac output(PiCCO)combined with rapid response system on monitoring of fluid resuscitation of the septic shock patients.METHODS The clinical data of 60 patients with septic shock who were diagnosed and treated in ICU of Wuhan No.1 Hospital from Jan 2018 to Jun 2018 were retrospectively analyzed,30 patients who were treated with conventional method for monitoring of effect of fluid resuscitation from Jan 2018 to Mar 2018 were chosen as the control group,30 patients who were treated with PiCCO combined with rapid response system for monitoring of effect of fluid resuscitation from Apr 2018 to Jun 2018 were assigned as the study group.The vasoactive drugs to maintain mean arterial pressure(MAP),vasoactive inotropic score,blood lactate level,urine volume and APACHEⅡscore were observed and compared between the two groups of patients before the treatment and after the treatment for 3 days.The mechanical ventilation duration,incidence of pulmonary edema and mortality rate of the two groups of patients were statistically analyzed.RESULTS After the treatment,the MAP,blood lactate level,vasoactive inotropic score and APACHEⅡscore of the two groups of patients showed downward trends,while the urine volume and oxygenation index showed upward trends(P<0.05).The MAP,blood lactate level,vasoactive inotropic score and APACHEⅡof the study group were significantly lower than those of the control group after the treatment for 3 days,while the urine volume of the study group was significantly higher than that of the control group(P<0.05).The mechanical ventilation duration,time of treatment with vasoactive drugs and length of ICU stay were significantly shorter in the study group than in the control group(P<0.05).The success rate of resuscitation of the study group was significantly higher than that of the control group,and the incidence of pulmonary edema of the study group was significantly lower than that of the control group(P<0.05).CONCLUSION The PiCCO combined with rapid response system may remarkably improve the clinical indexes of the patients with septic shock,raise the success rate of rescue and reduce the incidence of pulmonary edema.