CAJ | 학술논문

目的探讨脉搏指示剂连续性心排量( PiCCO)在重症急性胰腺炎( SAP)并急性呼吸窘迫综合征( ARDS)患者早期液体复苏中的应用. 方法收集2014-06~2015-06 期间40例SAP患者并ARDS患者,随机分为治疗组和对照组,所有患者均行PiCCO监测技术,治疗组患者在PiCCO监测下收集相应的血流动力学数据进行液体复苏,对照组患者仅收集PiCCO参数,按常规观察中心静脉压( CVP)、平均动脉压( MAP)等指标进行液体复苏,比较两组患者6 h及24 h复苏液体量、达标率、机械通气时间、血管活性药物使用情况、血流动力学参数、30 d病死率等结果.结果治疗组6 h及24 h复苏液体总量、复苏24 h的MAP、CVP、每小时尿量、全心舒张末期容积指数(GEDVI)、胸腔内血容量指数(ITBVI)、心排指数(CI)显著高于对照组(P<0.05),血管活性药物用量(去甲肾上腺素)、血管外肺水指数( EVLWI )、外周血管阻力( SVRI )、血清乳酸浓度(Lac)等指标显著低于对照组(P<0.05). 6 h内治疗组的复苏效率高于对照组(P<0.05),24 h内两组之间的复苏效率差异无统计学意义(P>0.05). 治疗组30 d病死率显著低于对照组(P<0.05 ). 治疗组PaO2/FiO2高于对照组( P<0.05 ). 对照组应用机械通气的概率较高,治疗组机械通气时间显著低于对照组(P<0.05). 结论 PiCCO监测技术简便、易行,在PiCCO技术指导下进行可控的液体复苏,对于SAP并ARDS患者能有效地改善血流动力学、组织灌注及氧代谢,减少血管活性药物用量,有效控制患者血管外肺水,减少机械通气时间,降低病死率.
목적 탐토맥박지시제련속성심배량( PiCCO)재중증급성이선염( SAP)병급성호흡군박종합정( ARDS)환자조기액체복소중적응용. 방법 수집2014-06~2015-06 기간40례SAP환자병ARDS환자,수궤분위치료조화대조조,소유환자균행PiCCO감측기술,치료조환자재PiCCO감측하수집상응적혈류동역학수거진행액체복소,대조조환자부수집PiCCO삼수,안상규관찰중심정맥압( CVP)、평균동맥압( MAP)등지표진행액체복소,비교량조환자6 h급24 h복소액체량、체표솔、궤계통기시간、혈관활성약물사용정황、혈류동역학삼수、30 d병사솔등결과.결과 치료조6 h급24 h복소액체총량、복소24 h적MAP、CVP、매소시뇨량、전심서장말기용적지수(GEDVI)、흉강내혈용량지수(ITBVI)、심배지수(CI)현저고우대조조(P<0.05),혈관활성약물용량(거갑신상선소)、혈관외폐수지수( EVLWI )、외주혈관조력( SVRI )、혈청유산농도(Lac)등지표현저저우대조조(P<0.05). 6 h내치료조적복소효솔고우대조조(P<0.05),24 h내량조지간적복소효솔차이무통계학의의(P>0.05). 치료조30 d병사솔현저저우대조조(P<0.05 ). 치료조PaO2/FiO2고우대조조( P<0.05 ). 대조조응용궤계통기적개솔교고,치료조궤계통기시간현저저우대조조(P<0.05). 결론 PiCCO감측기술간편、역행,재PiCCO기술지도하진행가공적액체복소,대우SAP병ARDS환자능유효지개선혈류동역학、조직관주급양대사,감소혈관활성약물용량,유효공제환자혈관외폐수,감소궤계통기시간,강저병사솔.
Objective To investigate the application of pulse indicator continuous cardiac output (PiCCO) in the early fluid resuscitation in patients with severe acute pancreatitis ( SAP) and acute respiratory distress syndrome (ARDS).Methods Forty cases of patients with SAP and ARDS treated in ICU were collected and randomly divided into control group and treatment group from June 2014 to June 2015 .All patients were monitored the PiCCO by a PiCCO monitor , and the patients in treatment group were treated with the resuscitation under the guides of PiCCO monitoring , but the patients in control group were treated with normal traditional fluid resuscitation according to the arterial pressure (MAP) of resuscitation 24 h and the central venous pressure (CVP).We compared with two groups of patients with 6 h, 24 h resuscitation liquid volume , compliance rate , mechanical ventilation time, blood flow dynamics parameters , 30-day mortality and other results .Results The 6 h, 24 h total fluid resuscitation, MAP of resuscitation 24 h, CVP, urine output per hour, dedicated end -diastolic volume index (GEDVI), intrathoracic blood volume index (ITBVI), cardiac index (CI) in the treatment group were significantly higher than those in the control group (P<0.05).The amount of vasoactive drugs ( noradrenaline ) , extravascular lung water index ( EVLWI ) , peripheral vascular resistance (SVRI), serum lactate concentration (Lac) and other indicators in the treatment group were significantly lower than those in the control group (P <0.05).In the resuscitation of compliance, treatment group recovery efficiency within6 h was higher( P<0.05), but no significant difference in recovery efficiency within 24 h between two groups (P>0.05).30-day mortality in treatment group was significantly lower than that in control group (P<0.05).The oxygenation index (PaO2/FiO2) in treatment group was significantly higher than that in control group (P<0.05).The control group showed a high probability of mechanical ventilation , and the duration of mechanical ventilation in treatment group was significantly shorter than that in the control group (P<0.05).Conclusion PiCCO is a simple hemodynamic technology .Under the guidance of PiCCO technology , we can control fluid resuscitation for patients with SAP and ARDS and improve hemodynamics effectively .The fluid resuscitation guided by PiCCO monitoring effectively improves tissue perfusion and oxygen metabolism , reduces the usage of blood vessel active drugs , controls extravascular lung water , and reduces the duration of mechanical ventilation and mortality .