脉搏指示连续心排血量监测在脓毒性休克中的应用  

Application of pulse indicator continuous cardiac output monitoring during septic shock

作　　者：谭小丽[1] 李峥[1] 刘丽秀[1] 甑小博 赖秋凤[1] 徐东珍[1] 唐红[1] 钟文娥[1] 

机构地区：[1]广西医科大学第十附属医院钦州市第一人民医院重症医学科,广西钦州535000

出　　处：《中国医药导报》2016年第22期172-175,共4页China Medical Herald

基　　金：广西壮族自治区临床重点专科建设项目资助(桂卫医[2014]13号);广西急诊与救援医学人才小高地开放课题(GXJZ201419)

摘　　要：目的探讨脉搏指示连续心排血量（PiCCO）监测在脓毒性休克的应用及护理效果。方法选择钦州市第一人民医院2013年6月～2015年12月入住ICU治疗的符合脓毒性休克患者69例，由患者或家属自愿选择监测方式，分为观察组（PiCCO2监测组）33例和对照组（传统监测组）36例，记录两组患者入ICU治疗6h、3d后液体总人量、APACHEⅡ评分及人ICU时与治疗3d后血浆氨基酸B型钠尿肽前体（NT—pro—BNP）和中心静脉压（CVP）前后差值水平及两组患者呼吸机支持时间、住ICU天数、28d病死率等进行比较和分析。结果观察组治疗3d后APACHEⅡ评分低于对照组，呼吸机支持时间及住ICU天数短于对照组，入ICU3d前后NT—pro—BNP变化差值（ANT—pro-BNP）大于对照组、入ICU 3d前后CVP变化差值（ACVP）的变化值小于对照组，差异有统计学意义（均P〈0．05）。入ICU6h和3d总液体入量及28d病死率比较差异无统计学意义（均P〉0．05）。结论PiC—CO2监测结合早期目标导向性治疗（EGDT）可有效指导容量复苏和后续治疗，缩短感染性休克患者呼吸机支持时间及住ICU时间，有利于改善脓毒性休克患者的危重度。Objective To investigate the application effect of pluse indicator continuous cardiac output （PiCCO） monitoring and nursing care of patients with septic shock. Methods According to voluntary choice by patients or their families monitoring, 69 cases with septic shock patients admitted into ICU of Qinzhou City First People＇s Hospital from June 2013 to December 2015 were selected and divided into observation group （PiCCO2 monitoring group） 33 cases and 36 cases of control group （traditional monitoring group）, two groups of patients in ICU treatment for 6 h, 3 days after the liquid in quantity, APACHE II score were recorded, and admission to the ICU amino acids in blood plasma B type natriuretic peptide precursor （NT-Pro-BNP） and central venous pressure （CVP） difference between before and after the level were also recorded, treatment in patients with ventilator support time, live ICU days, 28 day mortality rate were observed, and those were compared and analyzed in two groups. Results Patients in the observation group were treated 3 days after the APACHE II score was lower than that of the control group, the duration of ventilator support and live ICU days shorter than those of control group, into ICU 3 days before and after the NT Pro BNP difference （ANT-ProBNP） is greater than that of control group, the changes of CVP difference （ACVP） value was less than the control group, the difference had statistical significance （all P 〈 0.05）. There was no significant difference （all P 〉 0.05） in the total amount of liquid in ICU 6 h or 3 days and 28 day mortality rate. Conclusion PiCCO2 monitoring combined with early goal directed therapy （EGDT） can effectively guide capacity recovery and subsequent treatment, shorten the Ventilator support time and live ICU time in patients with septic shock patients, which is beneficial to improve the critical degree of patients with septic shock.

关 键 词：PiCCO2监测 脓毒性休克 护理 

分 类 号：R364.1[医药卫生—病理学]