PiCCO监测在脓毒血症合并急性肾损伤患者CRRT容量管理的应用研究  

Application study of pulse indicator continuous cardiac output in volume management of sepsis merge acute kidney injury during continuous renal replacement therapy

作　　者：傅丽琴[1] 杨向红[2] 富燕萍[2] FU Liqin YANG Xianghong FU Yanping.(Department of Critical Care,Zhe Jiang Provincial People＇ s Hospital, Hangzhou 310014, China)

机构地区：[1]浙江省人民医院1-10病区,浙江杭州310014 [2]浙江省人民医院ICU,浙江杭州310014

出　　处：《全科医学临床与教育》2016年第5期492-494,共3页Clinical Education of General Practice

基　　金：浙江省医药卫生一般研究计划(2013KYA010)

摘　　要：目的探讨脉波轮廓温度稀释连续心排量测量技术(Pi CCO)在脓毒血症合并急性肾损伤(AKI)患者连续性肾脏替代治疗(CRRT)容量管理中的应用价值。方法行CRRT治疗的脓毒血症合并AKI患者44例,随机分为观察组和对照组,观察组应用Pi CCO技术,监测中心静脉压(CVP)、胸腔内血容量指数(ITBI)、血管外肺水指数(ELWI)和体循环血管阻力指数(SVRI)的变化,于CRRT治疗前、治疗后12 h、24 h、72 h根据各参数的变化调节CRRT的液体平衡;对照组根据CVP的变化调节液体平衡。观察两组患者在去甲肾上腺素的用量、低血压的发生率方面是否存在差异。结果观察组在治疗12 h时,患者的ITBI和SVRI指标开始上升,ELWI开始下降,在随后的24 h、72 h,ITBI和ELWI趋于较稳定的水平,SVRI出现稳定的升高,观察组患者的ITBI、SVRI和ELWI在各时点差异均有统计学意义(F分别=7.08、11.36、131.40,P均<0.05),治疗期间各时点CVP差异无统计学意义(F=0.66,P>0.05)。观察组患者的去甲肾上腺素用量和低血压的发生率均明显低于对照组,差异均有统计学意义(t=0.02,χ2=4.66,P均<0.05)。结论 Pi CCO技术应用于脓毒血症合并AKI患者CRRT的容量管理更精确,更有利于病人顺利、平稳地耐受治疗。Objective To investigate the clinical value of pulse indicator continuous cardiac output（Pi CCO） in continuous renal replacement therapy（CRRT） capacity management of patients with sepsis merge acute kidney injury（AKI）. Methods Forty-four patients with sepsis merge AKI undergoing CRRT,randomly divided into the observation group and the control group. The observation group applied Pi CCO technology. The change of central venous pressure（CVP）,intrathoracic blood index（ITBI）,extravascular lung water index（ELWI）,systemic vascular resistance index（SVRI）,and other parameters at the time of 0 h,12 h,24 h and 72 h during the CRRT were measured with PICCO. The control group regulating liquid equilibrium according to the change of CVP. The differences between the two groups were observed in dosage of norepinephrine and incidence of hypotension.Results After 12 h on CRRT,the levels of ITBI,SVRI of the observation group began to rise,ELWI began to decline,in the following 24 h,72 h,the levels of ITBI and ELWI tend to be stable,levels of SVRI then rose gradually afterwards,the levels of ITBI,SVRI and ELWI of the observation group in each point difference had statistical significance（F =7.08,11.36,131.40,P 0.05）. The levels of CVP in each point were not significantly different（F=0.66,P0.05）. The dosage of norepinephrine and the incidence of hypotension of the observation group were significantly lower than those of the control group（t=0.02,χ2=4.66,P0.05）.Conclusion Capacity management application of Pi CCO technology in CRRT of patients with sepsis merge AKI is more accurate,more conducive to the smooth and steady treatment of patients.

关 键 词：脓毒血症 急性肾损伤 血流动力学 容量管理 血管外肺水 

分 类 号：R459.7[医药卫生—急诊医学] R692[医药卫生—治疗学]