CAJ | 학술논문

目的探讨脉波轮廓温度稀释连续心排监测技术(PICCO)在连续性肾脏替代治疗(CRRT)救治感染性休克患者中的应用效果.方法行CRRT治疗感染性休克患者34例,随机分为对照组和实验组各17例.对照组行常规的心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)等血流动力学监测,实验组除常规监测外,应用PICCO监测全心舒张末期容积指数(GEDI)、血管外肺水指数(EVLWI)、系统血管阻力指数(SVRI)等参数.2组均根据监测的血流动力学参数调整CRRT脱水量及液体复苏容量.观察治疗前、治疗后72 h的APACHEⅡ评分、CVP、MAP、乳酸值(Lac)、中心静脉血氧饱和度(ScvO2)、氧合指数(PaO2/FiO2)的变化.结果治疗后72 h,实验组的APACHEⅡ评分、Lac下降程度高于对照组,ScvO2上升程度高于对照组,PaO2/FiO2上升程度明显高于对照组.结论 PICCO指导CRRT救治感染性休克患者,能够精确调整患者的容量状况,改善组织循环,明显改善肺氧合,有利于感染性休克的救治.
목적 탐토맥파륜곽온도희석련속심배감측기술(PICCO)재련속성신장체대치료(CRRT)구치감염성휴극환자중적응용효과.방법 행CRRT치료감염성휴극환자34례,수궤분위대조조화실험조각17례.대조조행상규적심솔(HR)、평균동맥압(MAP)、중심정맥압(CVP)등혈류동역학감측,실험조제상규감측외,응용PICCO감측전심서장말기용적지수(GEDI)、혈관외폐수지수(EVLWI)、계통혈관조력지수(SVRI)등삼수.2조균근거감측적혈류동역학삼수조정CRRT탈수량급액체복소용량.관찰치료전、치료후72 h적APACHEⅡ평분、CVP、MAP、유산치(Lac)、중심정맥혈양포화도(ScvO2)、양합지수(PaO2/FiO2)적변화.결과 치료후72 h,실험조적APACHEⅡ평분、Lac하강정도고우대조조,ScvO2상승정도고우대조조,PaO2/FiO2상승정도명현고우대조조.결론 PICCO지도CRRT구치감염성휴극환자,능구정학조정환자적용량상황,개선조직순배,명현개선폐양합,유리우감염성휴극적구치.
Objective To explore application of pulse indicator continuous cardiac output(PICCO)in the treatment of septic shock during continuous renal replacement therapy (CRRT).Methods 34 patients with septic shock who underwent CRRT were randomly divided into the control group and the experimental group.Heart rate(HR),mean arterial pressure(MAP)and central venous pressure (CVP) were monitored in the control group.The experimental group were monitored by PICCO technology in addition to conventional monitoring,the hemodynamics parameters were collected such as end-diastolic volume index (GEDI),extravascular lung water index(EVLWI),and systemic vascular resistance index(SVRI),etc.Dehydration volume and supplementary volume were controlled by means of two group's hemodynamics parameters.The change of Acute Physiology And Chronic Health Evaluation-Ⅱ (APACHE Ⅱ),lactate (Lac),saturation of central venous oxygen(SevO2) and oxygenation index (PaO2/FiO2) were observed.Results After treatment of 72h,the decrease of APACHE Ⅱ and lactate in the experimental group was higher than those in the control group,the increase of ScvO2 in the experimental group was higher than those in the control group,the increase of PaO2/FiO2 in the experimental group was evidently higher than those in the control group.Conclusions During PICCO monitoring technique to guide CRRT therapy in patients with septic shock,the volume status of patients can be accurately controlled,organizational cycle can be improved,oxygenation of lung can be obviously improved,which contributes to treatment of septic shock.