PICCO监测在重症感染患者早期液体复苏治疗中的临床应用  

Clinical application of PICCO monitoring in patients with early fluid resuscitation in severe infection

作　　者：肖水明[1] 吴京兰[1] 张海钢[1] 杨新民[1] 周俊领[1] 袁运生[1] 庄瑞强[1] 洪全球[1] 阮红兵[1] 

机构地区：[1]广东医学院附属南山医院重症医学科,广东深圳518052

出　　处：《湘南学院学报（医学版）》2012年第4期15-18,共4页Journal of Xiangnan University（Medical Sciences）

摘　　要：目的探讨脉搏轮廓温度稀释连续心排量测量技术(PICCO)监测在重症感染患者早期液体复苏治疗(EGDT)中的临床应用。方法选择60例重症感染及感染性休克患者,应用PICCO监测技术进行床旁血流动力学监测,并根据监测指标指导患者液体复苏,记录患者HR、MAP、CVP、CI、SVV、ELWI、ITBI、GEDI液体复苏前后的变化。同时监测复苏前、复苏6 h及24 h后中心静脉血气分析、乳酸及碱剩余值及急性生理和慢性健康评分(APACHEⅡ)。结果应用PICCO监测血流动力学指标,发现MAP、CVP、CI、ITBI、GEDI均增高(P<0.05);SVV下降(P<0.05);而ELWI无明显增加(P>0.05)。复苏24 h乳酸清除率、ScvO_2、碱剩余及急性生理和慢性健康评分较复苏前有明显差异(P<0.01)。存活组EGDT达标比率远远高于死亡组。结论 PICCO血流动力学监测技术在重症感染及感染性休克患者早期液体复苏治疗中发挥着重要的作用。Objective To investigate the clinical application in patients with early fluid resuscitation （EGDT） the PICCO monitoring of severe infection. Methods 60 patients with severe infection and septic shock patients were detected with the PICCO monitoring technology to the bedside hemodynamic monitoring, and to guide fluid resuscitation of patients were recorded HR, MAP and CVP, CI, SVV, ELWI, ITBI, GEDI fluid resuscitation before and after the change. Monitoring recovery, 6 h and 24 h after the central venous blood gas analysis, lactate and base excess values and acute physiology and chronic health evaluation （ APACHE Ⅱ ）. Results application PICCO monitoring hemodynamics, MAP, CVP, CI, ITBI, GEDI were significantly higher（ P 〈 0.05 ） ; of SVV decreased（ P 〈 0.05） ; while ELWI are no increased significantly （ P 〉 0.05 ）. Recovery 24 h lactate clearance rate, ScvO2, base excess and acute physiology and chronic health evaluation, APACHE Ⅱ compared with the recovery before significant difference （ P 〈 0.01 ）. Survival group EGDT compliance ratio is much higher than the death group. Conclusion PICCO hemodynamic monitoring techniques play an important role in severe infection and septic shock in patients with early fluid resuscitation.

关 键 词：PICCO 血流动力学监测 重症感染 感染性休克 早期液体复苏治疗 

分 类 号：R541.64[医药卫生—心血管疾病]