CAJ | 학술논문

目的：分析脉搏指示连续心排血量（PiCCO）技术监测血管外肺水指数（ELWI）对ICU内老年重症肺炎并发呼吸衰竭患者液体管理的指导意义。方法42例老年重症肺炎机械通气患者随机分为PiCCO组和CVP组：PiCCO组以ELWI为目标进行容量管理，CVP组以中心静脉压（CVP）结合胸部影像学为参照进行容量管理，比较两组24 h、48 h、72 h的APACHEⅡ评分、氧合指数、血乳酸及混合静脉血氧饱和度（ScVO2）的变化，并观察两组液体出入量、机械通气时间、ICU住院时间及28 d病死率。结果 PiCCO组72 h APACHEⅡ评分较CVP组明显下降，差异有统计学意义（F=6.09，P＜0.05）。 PiCCO组48 h、72 h的氧合指数及ScVO2明显高于CVP组，而72 h血乳酸明显低于CVP组，差异均有统计学意义（F分别=32.69、36.51、21.65、97.67、9.21，P均＜0.05）。 PiCCO组在24 h、48 h、72 h时液体净入量均明显少于CVP组，差异均有统计学意义（F分别=67.62、127.38、31.66，P均＜0.05）。 PiCCO组的机械通气时间和ICU住院时间与CVP组比较均明显减少，差异均有统计学意义（F分别=12.05、10.72，P均＜0.05）。PiCCO组患者的28 d死亡率与CVP组比较有所下降，经Fisher精确概率检验，差异无统计学意义（P＞0.05）。结论老年重症肺炎患者进行PiCCO技术监测，根据ELWI指导液体复苏，能显著降低总入液量，明显改善患者氧合指数，减少呼吸机时间，缩短ICU住院时间。
목적：분석맥박지시련속심배혈량（PiCCO）기술감측혈관외폐수지수（ELWI）대ICU내노년중증폐염병발호흡쇠갈환자액체관리적지도의의。방법42례노년중증폐염궤계통기환자수궤분위PiCCO조화CVP조：PiCCO조이ELWI위목표진행용량관리，CVP조이중심정맥압（CVP）결합흉부영상학위삼조진행용량관리，비교량조24 h、48 h、72 h적APACHEⅡ평분、양합지수、혈유산급혼합정맥혈양포화도（ScVO2）적변화，병관찰량조액체출입량、궤계통기시간、ICU주원시간급28 d병사솔。결과 PiCCO조72 h APACHEⅡ평분교CVP조명현하강，차이유통계학의의（F=6.09，P＜0.05）。 PiCCO조48 h、72 h적양합지수급ScVO2명현고우CVP조，이72 h혈유산명현저우CVP조，차이균유통계학의의（F분별=32.69、36.51、21.65、97.67、9.21，P균＜0.05）。 PiCCO조재24 h、48 h、72 h시액체정입량균명현소우CVP조，차이균유통계학의의（F분별=67.62、127.38、31.66，P균＜0.05）。 PiCCO조적궤계통기시간화ICU주원시간여CVP조비교균명현감소，차이균유통계학의의（F분별=12.05、10.72，P균＜0.05）。PiCCO조환자적28 d사망솔여CVP조비교유소하강，경Fisher정학개솔검험，차이무통계학의의（P＞0.05）。결론노년중증폐염환자진행PiCCO기술감측，근거ELWI지도액체복소，능현저강저총입액량，명현개선환자양합지수，감소호흡궤시간，축단ICU주원시간。
Objective To evaluate the guidance value of monitoring extra lung water volume index by PiCCO for fluid management in elderly patients with severe pneumonia combined with respiratory failure. Methods A total of 42 cases of elderly patients with severe pneumonia who needed mechanical ventilation were divided into PiCCO group and CVP group. PiCCO group was taken capacity management through ELWI and CVP group was through CVP combined with chest radiog-raphy. The APACHE Ⅱ score, oxygenation index, blood lactate and mixed venous oxygen saturation (ScVO2) of two groups were compared. Fluid intake and output, duration of mechanical ventilation, ICU length of stay and 28-day mortal-ity at 24-hour, 48-hour and 72-hour were also observed. Results The APACHE Ⅱ score was significantly lower in PiCCO group at 72-hour than that in the CVP group(F=6.09,P<0.05). The Oxygenation index and ScVO2 in PiCCO group at 48-hour and 72-hour were significantly higher than those in the CVP group while the blood lactate at 72-hour was sig-nificantly lower than CVP group (F=32.69,36.51,21.65,97.67,9.21,P<0.05). Liquid net income were significantly re-duced in PiCCO group at 24-hour, 48-hour and 72-hour than those in the CVP group(F=67.62,127.38,31.66,P<0.05). Compared with CVP group, duration of mechanical ventilation and ICU stay were significantly reduced in PiCCO group (F=12.05,10.72,P<0.05). There was no significant difference was found in 28-day mortality between CVP group and PiCCO group (P>0.05). Conclusion Monitoring extra lung water volume index by PiCCO for fluid management in elderly patients with severe pneumonia combined with respiratory failure can significantly reduce the total fluid intake, improve patient oxygenation index, reduce ventilating time, shorten ICU length of stay and reduce mortality.