中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2013年
3期
263-267
,共5页
赵平%郑瑞强%陈齐红%邵俊
趙平%鄭瑞彊%陳齊紅%邵俊
조평%정서강%진제홍%소준
感染性休克%脉搏指示连续心排血量监测%液体复苏
感染性休剋%脈搏指示連續心排血量鑑測%液體複囌
감염성휴극%맥박지시련속심배혈량감측%액체복소
Septic shock%Pulse-indicate continuous cardiac output%Fluid resuscitation
目的 探讨脉搏指示连续心排血量(PICCO)监测技术在感染性休克患者液体复苏中的应用价值.方法 2010年1月至2011年12月58例感染性休克患者根据治疗过程中是否应用PICCO监测技术将患者分为PICCO组(28例)和对照组(30例),对比分析两组患者治疗后早期目标导向治疗的液体复苏(EGDT)达标率、乳酸水平、中心静脉压(CVP)、氧合指数,72 h内液体入量、液体平衡、ICU内呼吸机应用时间、ICU住院时间、ICU内72 h后多脏器功能不全(MODS)发生率、28 d病死率.结果 (1)与对照组比较,PICCO组72 h内总的液体入量[(9565±1623) ml与(12 245 ±2253)ml,t=2.673,P=0.021]及正平衡[(3656±1904) ml与(5465±2765) ml,t=2.357,P=0.012]较对照组明显减少.(2)PICCO组72 h氧合指数较对照组明显增高(252.6±87.4与226.8±69.4,P＜0.05),呼吸机应用时间较对照组明显缩短[(134.7±42.8)h与(193.3±92.4)h,t=1.356,P=0.023].(3)两组在相同时间段乳酸水平、CVP值、6 hEGDT达标率、ICU住院时间、72 h后ICU内MODS发生率、28 d病死率方面比较差异均无统计学意义(P均＞0.05).结论 与CVP指导的常规液体复苏相比,PICCO监测技术可以更准确地对感染性休克患者进行容量管理,指导早期液体复苏.
目的 探討脈搏指示連續心排血量(PICCO)鑑測技術在感染性休剋患者液體複囌中的應用價值.方法 2010年1月至2011年12月58例感染性休剋患者根據治療過程中是否應用PICCO鑑測技術將患者分為PICCO組(28例)和對照組(30例),對比分析兩組患者治療後早期目標導嚮治療的液體複囌(EGDT)達標率、乳痠水平、中心靜脈壓(CVP)、氧閤指數,72 h內液體入量、液體平衡、ICU內呼吸機應用時間、ICU住院時間、ICU內72 h後多髒器功能不全(MODS)髮生率、28 d病死率.結果 (1)與對照組比較,PICCO組72 h內總的液體入量[(9565±1623) ml與(12 245 ±2253)ml,t=2.673,P=0.021]及正平衡[(3656±1904) ml與(5465±2765) ml,t=2.357,P=0.012]較對照組明顯減少.(2)PICCO組72 h氧閤指數較對照組明顯增高(252.6±87.4與226.8±69.4,P＜0.05),呼吸機應用時間較對照組明顯縮短[(134.7±42.8)h與(193.3±92.4)h,t=1.356,P=0.023].(3)兩組在相同時間段乳痠水平、CVP值、6 hEGDT達標率、ICU住院時間、72 h後ICU內MODS髮生率、28 d病死率方麵比較差異均無統計學意義(P均＞0.05).結論 與CVP指導的常規液體複囌相比,PICCO鑑測技術可以更準確地對感染性休剋患者進行容量管理,指導早期液體複囌.
목적 탐토맥박지시련속심배혈량(PICCO)감측기술재감염성휴극환자액체복소중적응용개치.방법 2010년1월지2011년12월58례감염성휴극환자근거치료과정중시부응용PICCO감측기술장환자분위PICCO조(28례)화대조조(30례),대비분석량조환자치료후조기목표도향치료적액체복소(EGDT)체표솔、유산수평、중심정맥압(CVP)、양합지수,72 h내액체입량、액체평형、ICU내호흡궤응용시간、ICU주원시간、ICU내72 h후다장기공능불전(MODS)발생솔、28 d병사솔.결과 (1)여대조조비교,PICCO조72 h내총적액체입량[(9565±1623) ml여(12 245 ±2253)ml,t=2.673,P=0.021]급정평형[(3656±1904) ml여(5465±2765) ml,t=2.357,P=0.012]교대조조명현감소.(2)PICCO조72 h양합지수교대조조명현증고(252.6±87.4여226.8±69.4,P＜0.05),호흡궤응용시간교대조조명현축단[(134.7±42.8)h여(193.3±92.4)h,t=1.356,P=0.023].(3)량조재상동시간단유산수평、CVP치、6 hEGDT체표솔、ICU주원시간、72 h후ICU내MODS발생솔、28 d병사솔방면비교차이균무통계학의의(P균＞0.05).결론 여CVP지도적상규액체복소상비,PICCO감측기술가이경준학지대감염성휴극환자진행용량관리,지도조기액체복소.
Objective To investigate the value of pulse-indicate continuous cardiac output(PICCO) in septic shock patients.Methods In a retrospective study,58 patients who were diagnosed to be suffering from septic shock in the intensive care unit (ICU) were enrolled,from January 2010 to December 2011,and were divided into two groups:PICCO group(n =28) and the conventional group (n =30).We compared their 6 h-EGDT compliance rate,the level of lactate and central venous pressure (CVP),the oxygenation index,the characteristics of fluid intake and balance within 72 hours,duration of mechanical ventilation,and ICU stay of the two groups.The incidence of MODS after 72 hours in ICU,28-day mortality were recorded and compared.Results (1) Fluid intake((9565 ±1623) ml vs (12245±2253) ml,t=2.673,P=0.021) and balance ((3656 ± 1904) ml vs (5465 ± 2765) ml,t =2.357,P =0.012) were significantly lower in PICCO group compared the conventional group within 72 hours.(2) The oxygenation index ((252.6 ± 87.4) vs (226.8 ± 69.4),P ＜ 0.05) in PICCO group increased significantly and duration of mechanical ventilation ((134.7 ±42.8) h vs (193.3 ± 92.4) h,t =1.356,P =0.023) reduced significantly compared with the conventional group after 72 hours.(3) There was no difference in the 6 h-EGDT compliance rate,the level of lactate and CVP,6 h EGDT,ICU stay,the incidence rate of MODS after 72 hours,28-day mortality in ICU(P ＞0.05).Conclusion In contrast with classic methods as CVP monitoring,PICCO catheter may assess more accurately the volume status and guide early fluid resuscitation in septic shock patients.
