脉搏指示连续心排技术在老年脓毒症休克患者液体管理中的应用及对预后的影响  

Effect of pulse indicator of continuous cardiac output on the fluid management and prognosis of elderly patients with septic shock

作　　者：于晓春[1] 黄昭[1] 陈裕胜[1] 刘继云[1] 

机构地区：[1]广州市第一人民医院重症医学科,510180

出　　处：《实用医学杂志》2014年第8期1251-1254,共4页The Journal of Practical Medicine

摘　　要：目的:应用脉搏指示连续心排血量(PiCCO)技术监测老年脓毒症休克患者的血流动力学变化,并探讨其对预后的影响。方法:选取65例2008-2011年在我院ICU住院的老年脓毒症休克患者进行观察。应用PiCCO技术连续7 d监测血流动力学变化,并动态记录胸腔内血容量指数(ITBVI)、血管外肺水指数(EVLWI)、系统性血管张力指数(SVRI)等参数。比较不同预后患者参数指标,并进行独立危险因素分析。结果:65例老年脓毒症休克患者28 d死亡率为30/65(37.5%),28 d生存组患者血流动力学指标ITBVI及EVLWI数值均显著低于死亡组,且是老年脓毒症休克患者死亡的独立危险因素。结论:与传统的液体管理监测指标相比,应用PiCCO技术监测老年脓毒症休克患者的静态容量指标ITBVI及EVLWI是患者死亡的独立危险因素,将可能更为有效地判断患者血容量状态,并改善预后。Objective To investigate the changes of cardiovascular hemodynamics by pulse indicator continuous cardiac output （PiCCO） in elderly patients with septic shockand the 28-day mortality rate. Method Sixty-five consecutive elderly patients with septic shock were enrolled from December 2008 to December 2011, and cardiovascular hemodynamics including intrathoracic blood volume index （ITBVI）, extravascular lung water index （EVLWI） and clinical characteristics of them were collected and analyzed. Result The 28-day mortality rate of the elderly patients was 37.5%. No significant differences in fluid intake, fluid output or fluid balance （mL） were found within 0-7 day between survivors and non-survivors （P 〉 0.05）. However, compared with the survivors, non-survivors had lower levels of ITBVI and EVLWI, respectively （P 〈 0.05）. Result of the muhiple logistic regression analysis showed that APACHEII score, ITBVI and EVLWI were independent predictors of 28- day mortality rate （P 〈 0.05）. Conclusion Compared with by CVP, fluid management in elderly patients with septic shock directed by the measurements（ITBVI and EVLWI） of pulse indicator continuous cardiac output may contribute to the accurate evaluation of blood volume and to the effective improvement of prognosis.

关 键 词：脓毒症休克 胸腔内血容量指数 血管外肺水指数 

分 类 号：R459.7[医药卫生—急诊医学]