摘要
目的探讨脉搏指示连续心排血量监测技术(pulse indicator continuous cardiac output,PiCCO)在脓毒症休克患者血流动力学监测中的临床价值。方法 2012年1～8月,前瞻性队列研究比较常规监测(n=12)与PiCCO监测(n=19)脓毒症休克患者的血流动力学,应用PiCCO监测指导脓毒症休克患者的液体复苏、血管收缩药和正性肌力药物的使用。结果2组脓毒症休克患者性别、年龄、原发病、既往病史、多器官功能不全综合征(MODS)的发生和发生MODS器官数、急性生理学及慢性健康状况评分系统(APACHE)Ⅱ、脓毒症相关器官衰竭评分(SOFA)、应用去甲肾上腺素剂量和入ICU后7天总的输液量差异均无显著性,PiCCO组初始平均动脉压(MAP)明显低于常规组[(52.00±5.00)mm Hg vs.(59.58±3.42)mm Hg,t=4.603,P=0.000],而对于PiCCO组存在心功能损害的患者应用正性肌力药治疗后达到与常规组相同的MAP达标值[(68.00±2.43)mm Hg vs.(68.58±2.88)mm Hg,t=0.607,P=0.549],2组MAP达标值差异无显著性。结论在PiCCO监测指导下,可以对于存在心功能损害的患者应用正性肌力药物,而不是仅应用血管收缩药升高血压。
Objective To investigate the clinical value of pulse indicator continuous cardiac output （PiCCO） in hemodynamics monitoring for patients with septic shock. Methods A prospective cohort study comparing routine hemodynamics monitoring （n = 12） and PiCCO （ n = 19） for patients with septic shock were carried out from January to August 2012. The PiCCO monitor provided a continuous assessment of fluid resuscitation, vasopressors and inotropes infusion in septic shock patients. Results There were no significant difference between the two groups in sex, age, etiology of critical illness, medical history, incidence of MODS, number of MODS involved organ, APACHE II and SOFA scores, usage of noradrenaline, and total volume of fluid infusion in a week. In the PiCCO group, the original MAP was significantly lower than that in the routine group [ （52.00 ± 5.00） mm Hg vs. （59. 58± 3.42） mm Hg, t = 4. 603, P = 0. 000 ]. The patients who had impaired cardiac function reached to the same level of goal MAP as the routine group after taking inotropes [ （68.00 ± 2.43） mm Hg vs. （68.58 ± 2.8g） mm Hg, t = 0. 607, P = 0. 5491]No significant difference existed in the goal MAP between the two groups. Conclusion Under monitoring by PiCCO, not only vasopressors but also inotropes can be used to increase MAP for patients with cardiac dysfunction in septic shock.
出处
《中国微创外科杂志》
CSCD
2013年第3期202-205,共4页
Chinese Journal of Minimally Invasive Surgery
