中国血液流变学杂志
中國血液流變學雜誌
중국혈액류변학잡지
CHINESE JOURNAL OF HEMORHEOLOGY
2014年
4期
516-519
,共4页
脓毒性休克%早期目标导向治疗%脉波指示剂%连续心排血量监测
膿毒性休剋%早期目標導嚮治療%脈波指示劑%連續心排血量鑑測
농독성휴극%조기목표도향치료%맥파지시제%련속심배혈량감측
septic shock%early goal directed therapy%pulse index%continuous cardiac output
目的：探讨脉波指示剂连续心排血量监测（PiCCO）技术在脓毒性休克患者早期目标导向治疗（EGDT）中的临床指导价值。方法将60例脓毒性休克患者按随机数字表法分为常规监测组和PiCCO监测组各30例，PiCCO监测组在PiCCO技术指导下行EGDT，常规监测组患者放置中心静脉导管和桡动脉导管监测血流动力学，按照EGDT方案管理血流动力学并进行治疗。观察2组患者治疗6 h、24 h、48 h时EGDT达标率及复苏后相关参数：血乳酸水平，中心静脉血氧饱和度（ScvO2），中心静脉压（CVP），平均动脉压（MAP），尿量，液体正平衡量，多巴胺和多巴酚丁胺用量，死亡率。结果与常规监测组比较，PiCCO监测组6 h、24 h、48 h ScvO2升高，血乳酸水平降低，液体正平衡量升高，多巴酚丁胺、多巴胺用量减少（P＜0.05）。PiCCO监测组6 h、24 h达标率高于常规监测组，而30 d病死率低于常规监测组，差异均有统计学意义（P＜0.05）。结论对脓毒性休克患者在PiCCO技术指导下进行EGDT，可更快纠正血流动力学、氧代谢异常，改善患者预后。
目的：探討脈波指示劑連續心排血量鑑測（PiCCO）技術在膿毒性休剋患者早期目標導嚮治療（EGDT）中的臨床指導價值。方法將60例膿毒性休剋患者按隨機數字錶法分為常規鑑測組和PiCCO鑑測組各30例，PiCCO鑑測組在PiCCO技術指導下行EGDT，常規鑑測組患者放置中心靜脈導管和橈動脈導管鑑測血流動力學，按照EGDT方案管理血流動力學併進行治療。觀察2組患者治療6 h、24 h、48 h時EGDT達標率及複囌後相關參數：血乳痠水平，中心靜脈血氧飽和度（ScvO2），中心靜脈壓（CVP），平均動脈壓（MAP），尿量，液體正平衡量，多巴胺和多巴酚丁胺用量，死亡率。結果與常規鑑測組比較，PiCCO鑑測組6 h、24 h、48 h ScvO2升高，血乳痠水平降低，液體正平衡量升高，多巴酚丁胺、多巴胺用量減少（P＜0.05）。PiCCO鑑測組6 h、24 h達標率高于常規鑑測組，而30 d病死率低于常規鑑測組，差異均有統計學意義（P＜0.05）。結論對膿毒性休剋患者在PiCCO技術指導下進行EGDT，可更快糾正血流動力學、氧代謝異常，改善患者預後。
목적：탐토맥파지시제련속심배혈량감측（PiCCO）기술재농독성휴극환자조기목표도향치료（EGDT）중적림상지도개치。방법장60례농독성휴극환자안수궤수자표법분위상규감측조화PiCCO감측조각30례，PiCCO감측조재PiCCO기술지도하행EGDT，상규감측조환자방치중심정맥도관화뇨동맥도관감측혈류동역학，안조EGDT방안관리혈류동역학병진행치료。관찰2조환자치료6 h、24 h、48 h시EGDT체표솔급복소후상관삼수：혈유산수평，중심정맥혈양포화도（ScvO2），중심정맥압（CVP），평균동맥압（MAP），뇨량，액체정평형량，다파알화다파분정알용량，사망솔。결과여상규감측조비교，PiCCO감측조6 h、24 h、48 h ScvO2승고，혈유산수평강저，액체정평형량승고，다파분정알、다파알용량감소（P＜0.05）。PiCCO감측조6 h、24 h체표솔고우상규감측조，이30 d병사솔저우상규감측조，차이균유통계학의의（P＜0.05）。결론대농독성휴극환자재PiCCO기술지도하진행EGDT，가경쾌규정혈류동역학、양대사이상，개선환자예후。
Objective To investigate the application of pulse index continuous cardiac output (PiCCO) in patients with septic shock.MethodsSixty patients with septic shock were randomly divided into two groups: routine monitoring group and PiCCO monitoring group, with 30 patients in each group. The rate of reaching standard of early goal directed therapy (EGDT) was observed after treatment for 6, 24 and 48 hours. In addition, blood lactic acid, central venous oxygen saturation (ScvO2), central venous pressure (CVP), mean arterial pressure (MAP) and urine volume were determined after treatment for 6, 24 and 48 hours, and positive fluid balance amount and dosages of dopamine and dobutamine were measured after treatment for 6, 24 and 48 hours. Mortality was observed in the patients of both groups.Results After treatment for 6, 24 and 48 hours, in PiCCO monitoring group, ScvO2 signifi cantly increased, blood lactic acid level, positivefl uid balance amount, dosages of dopamine and dobutamine signifi cantly decreased compared with routine monitoring group (P<0.05). The rate of reaching standard of EGDT in PiCCO monitoring group was signifi cantly higher than that in routine monitoring group after treatment for 6, 24 hours. There also was difference in mortality between the two groups (P<0.05).Conclusion PiCCO monitor has an important clinical guide signifi cance for the resuscitation of septic shock, which can help to reach the fast and effective treatment target, improve septic shock, avoid the damage of blindfl uid infusion, provide fast and right treatment evidence. So it is worth being spread in clinic treatment.
