摘要
目的探讨脉搏指示连续心输出量(PiCCO)监测对脓毒性休克患者液体复苏治疗的价值。方法选取2013年5月至2015年5月76例脓毒性休克患者作为研究对象,进行随机分组;其中对照组38例,根据中心静脉压(CVP)指导液体复苏治疗;观察组38例,根据PiCCO监测参数值指导液体复苏治疗。对比两组患者复苏治疗的CVP、平均动脉压(MAP)、中心静脉血氧饱和度(ScvO2)、氧合指数[动脉血氧分压与呼入氧浓度的比值(PaO_2/FiO_2)]、血乳酸、机械通气时间、入住ICU天数及病死率;根据患者复苏治疗7 d后的存活与否,分为存活组与病死组,对比两组患者的PiCCO监测参数值。结果 76例患者复苏治疗7 d后,存活43例,病死33例,病死率43.42%;存活组与病死组患者的心脏指数(CI)、每搏量变异(SVV)、全心舒张末期容积指数(GEDI)、血管外肺水指数(ELWI)和MAP均具有统计学差异(P均<0.05);观察组患者复苏治疗后的CVP、MAP、ScvO2水平均显著高于对照组,PaO_2/FiO_2、血乳酸水平、病死率均显著低于对照组,机械通气时间、入住ICU天数均显著短于对照组,两组比较均有统计学差异(P均<0.05)。结论 PiCCO监测参数CI、SVV、GEDI、ELWI和MAP均与脓毒性休克患者的预后密切相关,根据PiCCO监测参数值指导脓毒性休克患者的液体复苏治疗,可显著纠正患者的血流动力学及氧代谢失常,协同提高临床疗效,改善预后。
Objective To investigate the guiding value of pulse-indicated continuous cardiac output （PiCCO） monitoring for fluid resuscitation therapy in patients with septic shock. Methods Seventy-six patients with septic shock were selected as research objective and were randomly divided into two groups （n = 38 each） ：control group [ fluid resuscitation therapy was guided by central venous pressure（CVP） ] and observation group（ fluid resuscitation therapy was guided by PiCCO monitoring parameters）. CVP, mean arterial pressure （MAP）, central venous oxygen saturation （ScvO2 ）, oxygenation index [ arterial partial pressure of oxygen/fraction of inspiration oxygen （PaO2/FiO2） ], blood lactic acid, mechanical ventilation time, ICU stay time and fatality rate were compared between two groups. Moreover, the patients were re-divided into survival group and death group according to survival or not of patients after resuscitation treatment of 7 days, and PiCCO monitoring parameters in the two groups were compared. Results Out of 76 cases after resuscitation treatment of 7 clays ,43 survived, and 33 cases died, so the fatality rate was 43.42%. There were significant differences in cardiac index （CI） , stroke volume variation （SVV） ,global end diastolic volume index （GEDI） ,external lung water index （ELWI） and MAP between survival group and death group （ all P 〈 0.05 ）. After resuscitation treatment, the levels of CVP, MAP and ScvOz in observation group were significantly higher than those in control group;PaO2/FiO2, blood lactic acid level and fatality rate in observation group were significantly lower than those in control group;mechanical ventilation time and ICU stay time in observation group were significantly shorter than those in control group （ all P 〈0.05）. Conclusions The PiCCO monitoring parame-ters CI, SVV, GEDI, ELWI and MAP are closely associated with the prognosis of patients with septic shock. The fluid resus-citation therapy guided by PiCCO monitoring parameters can significantly correct the abnormalities of hemodynamics and oxygen metabolism, cooperatively improve clinical efficacy and prognosis.
出处
《中国临床研究》
CAS
2016年第11期1466-1469,1476,共4页
Chinese Journal of Clinical Research
关键词
脓毒性休克
液体复苏治疗
脉搏指示持续心输出量
中心静脉压
Septic shock
Fluid resuscitation therapy
Pulse-indicated continuous cardiac output
Central venous pressure
