PiCCO指导下集束化治疗感染性休克的临床研究  

Clinical studies of surviving sepsis bundles according to PiCCO on septic shock patients

作　　者：卢年芳[1] 郑瑞强[1] 林华[1] 邵俊[1] 於江泉[1] 

机构地区：[1]江苏省苏北人民医院&扬州大学临床医学院ICU,扬州225001

出　　处：《中华危重病急救医学》2014年第1期23-27,共5页Chinese Critical Care Medicine

基　　金：基金项目：江苏省333高层次人才培养工程基金资助（2011-3）

摘　　要：目的探讨脉搏指示连续心排血量（PiCCO）监测指导下的早期目标导向治疗（EDGT）对感染性休克患者的治疗效果。方法选择2009年1月至2012年12月收住江苏省苏北人民医院的82例感染性休克患者，按随机数字表法分为传统集束化组（40例）和改良集束化组（42例）两组。传统集束化组按国际脓毒症指南标准给予常规EDGT集束化方案复苏。改良集束化组首先放置PiCCO导管，根据所测得的胸腔内血容量指数（ITBVI）指导液体复苏，使ITBVI达到850—1000mL／m2；并根据左心室收缩力指数（dPmax）和每搏量指数（SVI）等指标应用多巴酚丁胺调节心功能，使用去甲肾上腺素维持平均动脉压（MAP）1〉65mmHg（1mmHg=0．133kPa），同时监测血管外肺水指导液体选择和利尿剂的应用。观察两组患者治疗前后急性生理学与慢性健康状况评分系统Ⅱ（APACHE1／）评分和序贯器官衰竭评分（SOFA）、使用血管活性药物的例数、血清降钙素原（PCT）水平、动脉血乳酸、乳酸清除率、复苏液体量的变化及机械通气时间、住重症监护病房（ICU）时间、住院病死率。结果两组患者治疗后APACHEⅡ评分、SOFA评分、使用血管潘f生药物的例数均较治疗前逐渐降低，且治疗72h时改良集束化组显著低于传统集束化组[APACHEII评分（分）：13．1±6．5比20．9±7．5，SOFA评分（分）：8．8±4．3比14．6±4．9，使用血管活性药物的例数：8比17，均P〈O．05]。两组治疗后乳酸清除率均逐渐增加，改良集束化组各时间点乳酸清除率均明显高于传统集束化组[6h：（18．2±8．3）％比（10．8±7．5）％，t=-6．036，P=0．001；12h：（22．6±7．3）％比（12．4±8．1）％，t=-4．536，P=O．001；24h：（27．8±5．6）％kE（16．4±9．5）％，t=-5．882，P=0．000]。改良集束化组6h内使用复苏液体量明显多于传统集束化组（mL：36084-715比2809±Objective To explore the effect of early goal-directed therapy （EGDT） according to pulse indicated continuous cardiac output （PiCCO） on septic shock patients. Methods Eighty-two septic shock patients in Subei People＇s Hospital of Jiangsu Province from January 2009 to December 2012 were enrolled and randomly divided into two groups using a random number table, standard surviving sepsis bundle group （n = 40 ） and modified surviving sepsis bundles group （n =42）. The patients received the standard EGDT bundles in standard surviving sepsis bundle group. PiCCO catheter was placed in modified surviving sepsis bundles group. Fluid resuscitation was guided by intrathoracic blood volume index （ITBVI） with the aim of 850-1 000 mL/m2. Dobutamine was used to improve the heart function according to left ventricular contractile index （dPmax） and stroke volume index （ SVI ）. The mean arterial blood pressure （MAP） was maintained 65 mmHg （ 1 mmHg = 0.133 kPa） or above with norepinephrine. Extra-vascular lung water was monitored for the titration of liquid and diuretics. The acute physiology and chronic health evaluation 11 （APACHE II ） score, sequential organ failure assessment （SOFA） score, the number of patients needed vasopressor, serum procalcitonin （PCT）, lactic acid and lactate extraction ratio, the amount of fluid resuscitation, duration of mechanical ventilation, duration of intensive care unit （ICU） stay, hospital mortality were recorded in both groups. Results After treatment, the APACHE 11 score, SOFA score and the number of patients needed vasopressor were gradually reduced in both groups, and those in modified surviving sepsis bundle group were significantly lower than those of standard sepsis bundle group at 72 hours （APACHE I1 score： 13.1 ± 6.5 vs. 20.9 ± 7.5, SOFA score： 8.8 ± 4.3 vs.14.6 ±4.9, the number of patients needed vasopressor： 8 vs. 17, all P〈0.05 ）. Arterial blood lactate clearance rate was gradually increased after treatment in both g

关 键 词：感染性休克 集束化治疗 脉搏指示连续心排血量 

分 类 号：R459.7[医药卫生—急诊医学]