摘要
目的研究PiCCO心肺容量监护仪在危重烧伤患者的休克期和围术期应用的可行性。方法选取2008年5月-11月住院治疗的大面积危重烧伤患者10例,烧伤面积82.5%±15.7%,均在入院后3d内即行手术切痂,分别于休克期和围术期采用PiCCO进行血流动力学检测,项目包括平均动脉压(MAP)、心排出量指数(CI)、心功能指数(CFI)、胸腔内血容量指数(ITBI)、外周血管阻力指数(SVRI)、血管外肺水含量指数(ELWI),其中休克期监测6例次,围术期监测10例次。结果所有导管均留置成功,留置时间3.0±0.4d,导管尖细菌培养均为阴性,未发生导管并发症。患者烧伤后CI、CFI、ITBI均低于正常水平,SVRI高于正常水平,而后随着液体复苏的进行,36h后各项指标均逐渐恢复正常;MAP和EVLW无明显变化(P>0.05)。在围术期,经过严密的心肺容量监护,所有患者在休克期及感染期切痂过程中,除SVRI在切痂后显著降低、CFI在切痂后明显升高(P<0.05)外,余各项血流动力学指标均较平稳。结论采用PiCCO对严重烧伤患者的休克期和围术期进行血流动力学监测,可有效协助液体复苏及维护围术期患者生命体征的稳定。
Objective To investigate the feasibility of application of cardiopulmonary capacity monitor PiCCO in monitoring the hemodynamics of patients with serious burn in shock stage and perioperative periods.Methods Ten seriously burned patients with 82.5%±15.7% total body surface area burn and hospitalized from May 2008 to Nov.2008 were involved in the present study.All the patients underwent eschar excision within 3 days of hospitalization,and the hemodynamic indexes were monitored by PiCCO in the shock stage and perioperative period,including mean arterial pressure（MAP）,cardiac index（CI）,cardiac function index（CFI）,intrathoracic blood volume index（ITBI）,systemic vascular resistance index（SVRI）,and extravascular lung water（EVLW）.Monitoring was performed 6 times in shock stage and 10 times in perioperative period.Results All the catheters were successfully introduced,and the indwelling time was 3.0±0.4d.No complication due to catheterization occurred,and the bacterial cultivation was negative in all patients.The levels of CI,CFI and ITBI oarered markedly,and that of SVRI elevated in shock stage and then returned to normal level after fluid resuscitation（P〈0.05）.No significant change was found in the levels of MAP and EVLW after burn and resuscitation（P〉0.05）.During the perioperative period,the hemodynamic indexes of the patients were stable with careful cardiopulmonary capacity monitoring by PiCCO（P〉0.05）,except the SVRI reduced and CFI elevated after eschar excision（P〈0.05）.Conclusion Hemodynamic monitoring with PiCCO in shock stage and perioperative period for seriously burned patients is safe and feasible,and helpful for fluid resuscitation therapy and the maintenance of stable vital signs.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2009年第10期1228-1230,共3页
Medical Journal of Chinese People's Liberation Army
基金
全军医药卫生"十一五"重点课题资助项目(06Z054)
关键词
烧伤
监测
生理学
血液动力学过程
burns
monitoring
physiologic
hemodynamic processes
