TTE与PICCO联合监测指导脓毒性休克患者救治的临床应用研究  

Study on the clinical application of TTE and PICCO combined monitoring to guide the treatment of patients with septic shock

作　　者：王逸君[1,2] 莫晓君 许可 乐冬友[1] 曾振华[3] 徐自强 刘俊宏[1] 袁杰敏[1] Wang Yijun;Mo Xiaojun;Xu Ke;Yue Dongyou;Zeng Zhenhua;Xu Ziqiang;Liu Junhong;Yuan Jieming(Department of Emergency Medicine,the first people's hospital of Chenzhou;The First School Clinical Medicine,Southern Medical University;Department of Critical Care Medicine,Nanfang Hospital,Southern Medical University,Guangzhou,China)

机构地区：[1]郴州市第一人民医院急诊科 [2]南方医科大学第一临床医学院 [3]南方医院重症医学科

出　　处：《实用休克杂志（中英文）》2022年第5期274-280,共7页Journal of Practical Shock

基　　金：湖南省卫生健康委科研计划项目资助(项目编号:20201105);郴州市科学技术局科技发展计划项目资助(项目编号:zdyf201926);郴州市科学技术局科技发展计划项目资助(项目编号:ZDYF2020052);湘南学院自然科学项目资助资助(项目编号:2019XJ70)

摘　　要：目的观察TTE与PICCO联合监测指导脓毒性休克患者救治的临床疗效。方法选取2020年01月至2021年12月本院重症医学科住院的脓毒性休克患者44例,数字化随机分成两组,观察组23例,对照组21例。对照组采用传统监测方法,以CVP、被动抬高试验、补液试验、脉搏变异度及尿量变化等来指导液体复苏及救治;观察组除采用传统监测方法外,同时采用TTE与PICCO联合监测相关血流动力学,比较两组患者治疗的疗效与转归。结果两组患者治疗48h、72h后的CVP以及72h后PaO_(2)/FiO_(2)、ScvO_(2)、APACHEⅡ评分比较,差异均具有统计学意义(P<0.05);两组患者治疗48h后的Lac、BNP以及治疗72h后Lac、BNP、UO、PCT、CRP、IL-4、IL-6、TNF-α、IFN-γ以及血管活性药物平均评分比较,差异均具有统计学意义(P<0.05);观察组的入住ICU、总住院时间以及28d内死亡率均低于对照组,差异有统计学意义(P=0.045、0.028及0.043)。结论与传统监测方法相比较,TTE与PICCO联合监测更能有效指导脓毒性休克患者容量管理,能改善观察组患者危重程度,明显缩短观察组患者入住ICU及总住院时间,减少28d内死亡率。Objective Study on the treatment and clinical efficacy of TTE and PICCO combined monitoring to guide the treatment of patients with septic shock.Methods From January 2020 to December 2021,44 cases of septic shock patients hospitalized in the ICU of our hospital were randomly divided digitally into two groups,23 cases in the observation group and 21 cases in the control group.The control group used traditional monitoring methods,including CVP,passive elevation test,rehydration test,pulse variation and urine volume change to guide fluid resuscitation and treatment.In the observation group,in addition to the traditional monitoring methods,TTE combining with PICCO were used to monitor the hemodynamics,and the therapeutic efficacy and outcome of the two groups were compared.Results There were statistically significant differences in CVP after 48 h and 72 h treatment,as well as in PaO_(2)/FiO_(2),ScvO_(2)and APACHEⅡscores after 72 h treatment between the two groups(P<0.05);Lac,BNP after 48 h treatment and Lac,BNP,UO,PCT,CRP,IL-4,IL-6,TNF-α,IFN-γand mean scores of vasoactive drugs after 72 h treatment were significantly different between the two groups(P<0.05);ICU admission,total length of hospital stay and mortality within 28 days in the observation group were lower than those in the control group,the differences were statistically significant(P=0.045,0.028 and 0.043).Conclusions Compared with the traditional monitoring methods,TTE and PICCO combined monitoring can more effectively guide the volume management of the patients with septic shock,and improve the severity of patients,significantly shorten ICU admission and total hospital stay,and reduce the mortality within 28 days in the observation group.

关 键 词：TTE PICCO 脓毒性休克 血流动力学 

分 类 号：R459.7[医药卫生—急诊医学]