CAJ | 학술논문

目的：探究PICCO监测下白蛋白在左心功能不全伴严重感染患者液体复苏中的意义。方法：选取本院ICU确诊为心功能不全伴严重感染患者48例，随机数字表法分为实验组和对照组，每组24例，放置导管进行PICCO监测，实验组给予白蛋白补液，对照组给予常规晶体补液，动态监测患者的各项血流动力学的指标如中心静脉压（CVP）、心率（HR）、血管外肺水（EVLW）和全心舒张末期总容量指数（GEDVI）等。结果：治疗结束后，实验组患者的液体总入量、液体平衡量和血管外肺水相对于对照组均有明显改善，比较差异具有统计学意义（P<0.05）；两组患者在心脏指数（CI）、中心静脉压（CVP）和体循环阻力指数（SVRI）等方面比较差异无统计学意义（P>0.05），而实验组的全心舒张末期容量指数（GEDVI）相对于对照组有明显降低（P<0.05），且住院时长和机械通气都有明显缩短，实验组液体复苏成功率相较于对照组有明显提高。结论：PICCO监测下，白蛋白补液治疗对于左心功能不全合并严重感染患者的液体复苏疗效明显优于单纯晶体补液治疗。
목적：탐구PICCO감측하백단백재좌심공능불전반엄중감염환자액체복소중적의의。방법：선취본원ICU학진위심공능불전반엄중감염환자48례，수궤수자표법분위실험조화대조조，매조24례，방치도관진행PICCO감측，실험조급여백단백보액，대조조급여상규정체보액，동태감측환자적각항혈류동역학적지표여중심정맥압（CVP）、심솔（HR）、혈관외폐수（EVLW）화전심서장말기총용량지수（GEDVI）등。결과：치료결속후，실험조환자적액체총입량、액체평형량화혈관외폐수상대우대조조균유명현개선，비교차이구유통계학의의（P<0.05）；량조환자재심장지수（CI）、중심정맥압（CVP）화체순배조력지수（SVRI）등방면비교차이무통계학의의（P>0.05），이실험조적전심서장말기용량지수（GEDVI）상대우대조조유명현강저（P<0.05），차주원시장화궤계통기도유명현축단，실험조액체복소성공솔상교우대조조유명현제고。결론：PICCO감측하，백단백보액치료대우좌심공능불전합병엄중감염환자적액체복소료효명현우우단순정체보액치료。
Objective:To explore the effect of albumin on patients’ fluid recovery with left cardiac insufficiency and severe infection under the PICCO detection.Method:48 ICU patients with diagnosis of left cardiac insufficiency and severe infection were selected and divided into two groups randomly,24 cases for each group.The control group was given clinical routine crystal rehydration while the experimental group was given albumin rehydration besides other treatment.The hemodynamic indexes such as central venous pressure (CVP),heart rate (HR),blood vessels lung water (EVLW) and the whole heart end-diastolic total capacity index (GEDVI) were monitored under the PICCO detection.Result:After the treatment,the liquid balance amount,the total liquid amount and EVLW of the experimental group were obviously improved with statistical significance compared to the control group(P<0.05),while there was no remarkable change in CI,CVP and SVRI between the two groupsexcept that the GEDVI of the experimental group significantly reduced(P<0.05),Moreover,the mechanical ventilation time and ICU hospitalization day of the experimental group were shorter than the control group (P<0.05),the albumin treatment improved the fluid recovery more effectively than the crystal treatment.Conclusion:Under the detection of PICCO,albumin rehydration treatment is superior to pure crystal rehydration treatment for the liquid recovery of the patients with left cardiac insufficiency and severe infection.