CAJ | 학술논문

对1例体外超声碎石时出现“呼吸困难、血压低，伴心悸、胸闷、全身大汗”临床考虑为重度肺毛细血管渗漏、低血容量性休克的患者行脉搏波指示连续心排血量（PiCCO）技术监测，动态观察各血流动力学指标，根据血管外肺水指数（EVLWI）及全心舒张末容积指数（GEDI）控制性补液，纠正休克治疗过程中该患者心排量（CO）和GEDI一直偏低，EVLWI最高达到了32 ml/kg，持续可吸出大量淡红色稀薄血性痰，高呼吸机支持参数下氧饱和度仍然非常低。为纠正休克同时减轻肺水肿选择了控制性补液，即当GEDI低于500 ml/m2时选择补充胶体液，当GEDI高于500 ml/m2时减少补液量并减慢补液速度，保持轻度容量不足并及时调整呼吸机参数，经治疗后患者胸片肺水肿逐渐好转，乳酸，肝肾功能，逐渐好转，6 d后停用升压药，10 d后脱呼吸机并拔除经口气管插管，25 d后顺利出院。在治疗过程中PiCCO监测有重要的指导意义。
대1례체외초성쇄석시출현“호흡곤난、혈압저，반심계、흉민、전신대한”림상고필위중도폐모세혈관삼루、저혈용량성휴극적환자행맥박파지시련속심배혈량（PiCCO）기술감측，동태관찰각혈류동역학지표，근거혈관외폐수지수（EVLWI）급전심서장말용적지수（GEDI）공제성보액，규정휴극치료과정중해환자심배량（CO）화GEDI일직편저，EVLWI최고체도료32 ml/kg，지속가흡출대량담홍색희박혈성담，고호흡궤지지삼수하양포화도잉연비상저。위규정휴극동시감경폐수종선택료공제성보액，즉당GEDI저우500 ml/m2시선택보충효체액，당GEDI고우500 ml/m2시감소보액량병감만보액속도，보지경도용량불족병급시조정호흡궤삼수，경치료후환자흉편폐수종축점호전，유산，간신공능，축점호전，6 d후정용승압약，10 d후탈호흡궤병발제경구기관삽관，25 d후순리출원。재치료과정중PiCCO감측유중요적지도의의。
A male patient undergoing extracorporeal ultrasound lithotripsy developed the symptoms of dyspnea, low blood pressure, palpitations, chest tightness, and sweating, and a clinical diagnosis of pulmonary capillary leak and hypovolemic shock was made. Pulse indicator continuous cardiac output (PiCCO) technique was used for resuscitation according to the measurements of extravascular lung water index (EVLWI) and global end-diastolic volume index (GEDI). The patient showed low levels of cardiac output (CO) and GEDI with a peak EVLWI of 32 ml/kg and profuse pink and thin sputum overflow from the trachea. The high ventilator support parameters failed to correct low oxygen saturation. Restricted fluid infusion was used to reduce pulmonary edema. Colloidal solution was given when GEDI was below 500 ml/m2, and the volume and fluid infusion rate were reduced for a GEDI higher than 500 ml/m2. Pulmonary edema was gradually reduced after the treatments with improvement of lactic acid level and liver and kidney functions. Vasopressors were withdrawn 6 days later, mechanical ventilation was discontinued 10 days later, and tracheal intubation was removed 25 days later, after which the patient was discharged. In the treatment of the patient, PiCCO monitoring played an important role.