当代医药论丛
噹代醫藥論叢
당대의약론총
Contemporary Medicine Forum
2014年
18期
208-210
,共3页
木塔里甫·买合木提%肖东
木塔裏甫·買閤木提%肖東
목탑리보·매합목제%초동
感染性休克%脉搏指示连续心排血量%疗效
感染性休剋%脈搏指示連續心排血量%療效
감염성휴극%맥박지시련속심배혈량%료효
Septic shock%Pulse indicated continuous cardiac output%effect
目的：探讨在脉搏指示连续心排血量(PICCO)监测下对感染性休克患者进行早期液体复苏的效果。方法：选取新疆维吾尔自治区人民医院2013年1月至2014年7月期间收治的82例感染性休克患者作为研究对象。按照随机数字表法将其分为PICCO组和常规组，PICCO组有32例患者，常规组有50例患者。为PICCO组患者放置PICCO导管，根据所测得的患者胸腔内血容量指数(ITBVI)指导液体复苏，根据患者血管外肺水情况选择液体，使用利尿剂。为常规组患者按常规EDGT集束化方案进行液体复苏。观察两组患者的APACHEⅡ评分、SOFA、血清降钙素原(PCT)的水平、乳酸清除率、复苏液体量的变化、机械通气的时间、入住ICU的时间、治疗一周后的死亡例数、肺水肿的发生例数。结果：经过治疗后，两组患者的APACHE II评分、SOFA评分均有所下降，且PICCO组患者下降的幅度大于常规组患者，差异显著，具有统计学意义（P＜0.05）；两组患者的氧合指数和MAP逐渐升高；两组患者的血PCT值逐渐下降，72个小时后下降幅度更加明显，与治疗前相比，差异显著，具有统计学意义(P＜0.05)；两组患者的CVP值在6个小时后均有所升高，与治疗前相比，差异显著，具有统计学意义（P＜0.05）；PICCO组患者的乳酸清除率明显高于常规组患者，差异显著，具有统计学意义（P＜0.05）；PICCO组患者在24个小时后复苏液体量明显少于常规组患者，差异显著，具有统计学意义（P＜0.05）；PICCO组患者机械通气的时间、入住ICU的时间、肺水肿的发生例数均优于常规组患者，差异显著，具有统计学意义（P＜0.05）；PICCO组患者治疗一周后的死亡例数少于对照组患者，差异不显著，无统计学差异（P＞0.05）。结论：在PICCO监测下对感染性休克患者进行早期液体复苏更为准确和有效，可减少患者出现肺水肿的情况，缩短其机械通气的时间和入住ICU的时间。此疗法值得在临床上推广应用。
目的：探討在脈搏指示連續心排血量(PICCO)鑑測下對感染性休剋患者進行早期液體複囌的效果。方法：選取新疆維吾爾自治區人民醫院2013年1月至2014年7月期間收治的82例感染性休剋患者作為研究對象。按照隨機數字錶法將其分為PICCO組和常規組，PICCO組有32例患者，常規組有50例患者。為PICCO組患者放置PICCO導管，根據所測得的患者胸腔內血容量指數(ITBVI)指導液體複囌，根據患者血管外肺水情況選擇液體，使用利尿劑。為常規組患者按常規EDGT集束化方案進行液體複囌。觀察兩組患者的APACHEⅡ評分、SOFA、血清降鈣素原(PCT)的水平、乳痠清除率、複囌液體量的變化、機械通氣的時間、入住ICU的時間、治療一週後的死亡例數、肺水腫的髮生例數。結果：經過治療後，兩組患者的APACHE II評分、SOFA評分均有所下降，且PICCO組患者下降的幅度大于常規組患者，差異顯著，具有統計學意義（P＜0.05）；兩組患者的氧閤指數和MAP逐漸升高；兩組患者的血PCT值逐漸下降，72箇小時後下降幅度更加明顯，與治療前相比，差異顯著，具有統計學意義(P＜0.05)；兩組患者的CVP值在6箇小時後均有所升高，與治療前相比，差異顯著，具有統計學意義（P＜0.05）；PICCO組患者的乳痠清除率明顯高于常規組患者，差異顯著，具有統計學意義（P＜0.05）；PICCO組患者在24箇小時後複囌液體量明顯少于常規組患者，差異顯著，具有統計學意義（P＜0.05）；PICCO組患者機械通氣的時間、入住ICU的時間、肺水腫的髮生例數均優于常規組患者，差異顯著，具有統計學意義（P＜0.05）；PICCO組患者治療一週後的死亡例數少于對照組患者，差異不顯著，無統計學差異（P＞0.05）。結論：在PICCO鑑測下對感染性休剋患者進行早期液體複囌更為準確和有效，可減少患者齣現肺水腫的情況，縮短其機械通氣的時間和入住ICU的時間。此療法值得在臨床上推廣應用。
목적：탐토재맥박지시련속심배혈량(PICCO)감측하대감염성휴극환자진행조기액체복소적효과。방법：선취신강유오이자치구인민의원2013년1월지2014년7월기간수치적82례감염성휴극환자작위연구대상。안조수궤수자표법장기분위PICCO조화상규조，PICCO조유32례환자，상규조유50례환자。위PICCO조환자방치PICCO도관，근거소측득적환자흉강내혈용량지수(ITBVI)지도액체복소，근거환자혈관외폐수정황선택액체，사용이뇨제。위상규조환자안상규EDGT집속화방안진행액체복소。관찰량조환자적APACHEⅡ평분、SOFA、혈청강개소원(PCT)적수평、유산청제솔、복소액체량적변화、궤계통기적시간、입주ICU적시간、치료일주후적사망례수、폐수종적발생례수。결과：경과치료후，량조환자적APACHE II평분、SOFA평분균유소하강，차PICCO조환자하강적폭도대우상규조환자，차이현저，구유통계학의의（P＜0.05）；량조환자적양합지수화MAP축점승고；량조환자적혈PCT치축점하강，72개소시후하강폭도경가명현，여치료전상비，차이현저，구유통계학의의(P＜0.05)；량조환자적CVP치재6개소시후균유소승고，여치료전상비，차이현저，구유통계학의의（P＜0.05）；PICCO조환자적유산청제솔명현고우상규조환자，차이현저，구유통계학의의（P＜0.05）；PICCO조환자재24개소시후복소액체량명현소우상규조환자，차이현저，구유통계학의의（P＜0.05）；PICCO조환자궤계통기적시간、입주ICU적시간、폐수종적발생례수균우우상규조환자，차이현저，구유통계학의의（P＜0.05）；PICCO조환자치료일주후적사망례수소우대조조환자，차이불현저，무통계학차이（P＞0.05）。결론：재PICCO감측하대감염성휴극환자진행조기액체복소경위준학화유효，가감소환자출현폐수종적정황，축단기궤계통기적시간화입주ICU적시간。차요법치득재림상상추엄응용。
Objective To explore the effect of early fluid resuscitation (EGDT)according to pulseindicated continuous cardiac output (PICCO)on septic shock patients.Methods Eighty-two septic shock patients in Xinjiang autonomous region people’s hospital from January 2013 to July 2014 were enrolled and randomly divided into two groups using a random number table,PICCO group (n=32)and standard surviving sepsis bundle group (n=50).PICCO catheter was placed in PICCO group, fluid resuscitation was guided byintrathoracic blood volume index (ITBVI) ,Extravascular lung water was monitored for the titration of liquid and diuretics.The patients received the standard EGDT bundles in standard surviving sepsis bundle group .The acute physiology and chronic health evaluation Ⅱ(APACHE II)score,sequential organ failure assessment (SOFA)score, serum procalcitonin (PCT),lactate extraction ratio,the amount of fluid resuscitation,duration of mechanical ventilation, durationofintensive careunit(ICU)stay, mortality were recorded in both groups. Results APACHE Ⅱ score, SOFA score were reduced in two groups after treatment.the APACHE Ⅱ score PICCO 72 hours was significantly lower than normal group (17.6±5.3VS 21.4±8.3, P<0.05); lactate extraction ratio increase in the two groups, after treating 72 hours PICCO group were significantly higher than the conventional group (26.2±10.1 VS 16.8±6.5,P<0.05); Within the two groups blood PCT value decline gradually, group was statistically significant (P < 0.05); Two groups of recovery liquid volume within the group and between groups had statistical differences (P<0.05), PICCO group in 24 hours, the amount of liquid is less than the conventional group; Two groups lived in mechanical ventilation time and ICU time, incidence of pulmonary edema were statistically difference (P < 0.05), and the PICCO group lived in mechanical ventilation time and ICU time, the incidence of pulmonary edema were less than the conventional group; A week after treatment in the two groups of mortality is no statistical difference (P > 0.05). Conclusions PICCO can reduce the severity of disease in patients with septic shock,can make more accurately guide fluid resuscitation,and can reduce lung water and duration of mechanical ventilation and ICU stay.It has greatclinical significance.
