中国医药
中國醫藥
중국의약
CHINA MEDICINE
2013年
3期
332-334
,共3页
郭应军%孟繁甦%王国军%刘八一%岑英文%周丹丹
郭應軍%孟繁甦%王國軍%劉八一%岑英文%週丹丹
곽응군%맹번소%왕국군%류팔일%잠영문%주단단
脉搏指示连续心排出量%中心静脉测压%肺炎,重症%液体管理
脈搏指示連續心排齣量%中心靜脈測壓%肺炎,重癥%液體管理
맥박지시련속심배출량%중심정맥측압%폐염,중증%액체관리
Pulse indicates the continuous cardiac emissions technology%Central venous pressure measurement%Pneumonia,severe%Fluid management
目的 分析脉搏指示连续心排出量(PiCCO)技术对ICU内重症肺炎患者液体管理的指导意义.方法 回顾性分析我院ICU内2010年11月至2011年8月期间采用PiCCO技术的15例重症肺炎患者(PiCCO组)的临床资料,选择同期仅CVP监测的重症肺炎患者15例为CVP组.分别记录各组的临床肺部感染评分(CPIS),记录监测第24、48、72小时的全心舒张末期容积(GEDV)、胸腔内血容量(ITBV)、脉压变异率(PPV)、血管外肺水(EVLW)及中心静脉压(CVP)；进行GEDV、ITBV与CVP及EVLW与氧合指数之间的相关性分析.结果 PiCCO组第48、72小时氧合指数明显高于CVP组[分别为(157±43)比(83 ±39),(216 ±40)比(163 ±37)],血乳酸及CPIS明显低于CVP组[血乳酸:分别为(2.4 ±0.6)mmol/L比(3.0±1.1) mmol/L,(1.1±0.5) mmol/L比(2.5±0.8)mmol/L; CPIS:分别为(5.3±1.7)分比(6.4±2.1)分,(3.1±1.5)分比(5.3±1.6)分],差异均有统计学意义(均P＜0.05).PiCCO组第48、72小时总入量及液体出入平衡量明显少于CVP组[总入量:分别为(2836±291) ml比(3351 ±510) ml,(2510±203)ml比(2981±301) ml;液体平衡量:分别为(251±147) ml比(764±211) ml,(217±212) ml比(443±176) ml],差异均有统计学意义(均P＜0.05).PiCCO组的呼吸机使用时间和ICU住院时间均明显少于CVP组[分别为(11 ±4)d比(18±5)d,(13 ±5)d比(19±5)d],差异均有统计学意义(均P＜0.05)；2组患者住院费用比较差异无统计学意义(P＞0.05).GEDV与CVP及ITBV与CVP相关系数分别为-0.134、-0.145,相关性较弱(P＞0.05).第48、72小时的EVLW与相应点氧合指数相关系数分别为-0.414、-0.465,相关性强(P＜0.05).结论 PiCCO技术有助于了解重症肺炎患者液体复苏情况,能明显降低总入液量,明显改善患者氧合指数,减少呼吸机时间,缩短ICU住院时间,不增加患者治疗费用.
目的 分析脈搏指示連續心排齣量(PiCCO)技術對ICU內重癥肺炎患者液體管理的指導意義.方法 迴顧性分析我院ICU內2010年11月至2011年8月期間採用PiCCO技術的15例重癥肺炎患者(PiCCO組)的臨床資料,選擇同期僅CVP鑑測的重癥肺炎患者15例為CVP組.分彆記錄各組的臨床肺部感染評分(CPIS),記錄鑑測第24、48、72小時的全心舒張末期容積(GEDV)、胸腔內血容量(ITBV)、脈壓變異率(PPV)、血管外肺水(EVLW)及中心靜脈壓(CVP)；進行GEDV、ITBV與CVP及EVLW與氧閤指數之間的相關性分析.結果 PiCCO組第48、72小時氧閤指數明顯高于CVP組[分彆為(157±43)比(83 ±39),(216 ±40)比(163 ±37)],血乳痠及CPIS明顯低于CVP組[血乳痠:分彆為(2.4 ±0.6)mmol/L比(3.0±1.1) mmol/L,(1.1±0.5) mmol/L比(2.5±0.8)mmol/L; CPIS:分彆為(5.3±1.7)分比(6.4±2.1)分,(3.1±1.5)分比(5.3±1.6)分],差異均有統計學意義(均P＜0.05).PiCCO組第48、72小時總入量及液體齣入平衡量明顯少于CVP組[總入量:分彆為(2836±291) ml比(3351 ±510) ml,(2510±203)ml比(2981±301) ml;液體平衡量:分彆為(251±147) ml比(764±211) ml,(217±212) ml比(443±176) ml],差異均有統計學意義(均P＜0.05).PiCCO組的呼吸機使用時間和ICU住院時間均明顯少于CVP組[分彆為(11 ±4)d比(18±5)d,(13 ±5)d比(19±5)d],差異均有統計學意義(均P＜0.05)；2組患者住院費用比較差異無統計學意義(P＞0.05).GEDV與CVP及ITBV與CVP相關繫數分彆為-0.134、-0.145,相關性較弱(P＞0.05).第48、72小時的EVLW與相應點氧閤指數相關繫數分彆為-0.414、-0.465,相關性彊(P＜0.05).結論 PiCCO技術有助于瞭解重癥肺炎患者液體複囌情況,能明顯降低總入液量,明顯改善患者氧閤指數,減少呼吸機時間,縮短ICU住院時間,不增加患者治療費用.
목적 분석맥박지시련속심배출량(PiCCO)기술대ICU내중증폐염환자액체관리적지도의의.방법 회고성분석아원ICU내2010년11월지2011년8월기간채용PiCCO기술적15례중증폐염환자(PiCCO조)적림상자료,선택동기부CVP감측적중증폐염환자15례위CVP조.분별기록각조적림상폐부감염평분(CPIS),기록감측제24、48、72소시적전심서장말기용적(GEDV)、흉강내혈용량(ITBV)、맥압변이솔(PPV)、혈관외폐수(EVLW)급중심정맥압(CVP)；진행GEDV、ITBV여CVP급EVLW여양합지수지간적상관성분석.결과 PiCCO조제48、72소시양합지수명현고우CVP조[분별위(157±43)비(83 ±39),(216 ±40)비(163 ±37)],혈유산급CPIS명현저우CVP조[혈유산:분별위(2.4 ±0.6)mmol/L비(3.0±1.1) mmol/L,(1.1±0.5) mmol/L비(2.5±0.8)mmol/L; CPIS:분별위(5.3±1.7)분비(6.4±2.1)분,(3.1±1.5)분비(5.3±1.6)분],차이균유통계학의의(균P＜0.05).PiCCO조제48、72소시총입량급액체출입평형량명현소우CVP조[총입량:분별위(2836±291) ml비(3351 ±510) ml,(2510±203)ml비(2981±301) ml;액체평형량:분별위(251±147) ml비(764±211) ml,(217±212) ml비(443±176) ml],차이균유통계학의의(균P＜0.05).PiCCO조적호흡궤사용시간화ICU주원시간균명현소우CVP조[분별위(11 ±4)d비(18±5)d,(13 ±5)d비(19±5)d],차이균유통계학의의(균P＜0.05)；2조환자주원비용비교차이무통계학의의(P＞0.05).GEDV여CVP급ITBV여CVP상관계수분별위-0.134、-0.145,상관성교약(P＞0.05).제48、72소시적EVLW여상응점양합지수상관계수분별위-0.414、-0.465,상관성강(P＜0.05).결론 PiCCO기술유조우료해중증폐염환자액체복소정황,능명현강저총입액량,명현개선환자양합지수,감소호흡궤시간,축단ICU주원시간,불증가환자치료비용.
Objective To analyze the guiding significance of the pulse indicate continuous cardiac output (PiCCO) technology for fluid management of patients with severe pneumonia in ICU.Methods From November 2010 to August 2011 in ICU in our hospital,15 cases of severe pneumonia treated with PiCCO were included(PiCCO group),and another 15 cases treated with CVP monitoring alone during the same period were included in CVP group.Separately clinical pulmonary infection score (the CPIS) was recorded and end-diastolic volume (GEDV),intrathoracic blood volume (ITBV),pulse pressure variation rate (PPV),extravascular lung water (EVLW) and central venous pressure (CVP) at 24,48 and 72 hours were recorded.The relationship of GEDV,ITBV,CVP,EVLW and the oxygenation index was calculated.Results In the PiCCO group,oxygenation index of 48 hours and 72 hours was significantly higher than that in CVP group [(157 ± 43) vs (83 ± 39),(216 ± 40) vs (163 ± 37)],and blood lactate and CPIS were lower than thaose in CVP group [blood lactate:(2.4 ± 0.6) mmol/L vs (3.0 ±1.1) mmol/L (1.1 ± 0.5) mmol/L vs (2.5 ± 0.8) mmol/L; CPIS:(5.3 ± 1.7) scores vs (6.4 ± 2.1) scores,(3.1 ± 1.5) scores vs (5.3 ± 1.6) scores],and the differences were statistically significant (P ＜ 0.05).The total intake and fluid balance amount of the PiCCO group was significantly less than those in CVP group in 48 hours,72 hours [total intake:(2836 ±291)ml vs (3351 ±510)ml,(2510 ±203)ml vs (2981 ±301)ml; amount of fluid balance:(251 ± 147)ml vs (764 ±211)ml,(217 ±212)ml vs (443 ± 176)ml respectively,all P＜0.05].Ventilator time and length of ICU of the PiCCO group were significantly less than those in CVP group [(11 ± 4) d vs (18 ± 5) d,(13 ± 5) d vs (19 ± 5) d,respectively,P ＜ 0.05] ; Hospitalization costs of two groups was not statistically significant (P ＞0.05).The correlation coefficients of GEDV with CVP and ITBV with CVP were-0.134,-0.145,the correlation was weak (P ＞ 0.05).At 48 hours and 72 hours,the correlation coefficients of EVLW and the oxygenation index were-0.414,-0.465,and the correlation was strong(P＜0.05).Conclusions It is helpful to know the fluid resuscitation of severe pneumonia with PICCO.PiCCO can reduce the total fluid volume,improve oxygenation index,reduce the time of ventilator and shorten the length of ICU stay.
