PiCCO联合ScvO2监测对重症急性胰腺炎早期液体管理的临床研究  

Clinical study on early - stage liquid management of severe acute pancreatitis under the combination of PiCCO and ScvO2 supervision

作　　者：贵春梅[1] 黄绍华[1] 李俊蓉[1] 陈智峰[1] 

机构地区：[1]常德市第一人民医院重症医学科,湖南常德415000

出　　处：《中国急救医学》2017年第2期145-148,共4页Chinese Journal of Critical Care Medicine

基　　金：基金项目：常德市社会发展关键技术及产品科研项目（2014sk03）

摘　　要：目的通过脉搏指示连续心排血量（PiCCO）联合中心静脉血氧饱和度（ScvO2）监测对重症急性胰腺炎（SAP）早期液体精确管理，了解其临床意义。方法采用前瞻性随机对照的研究方法，选择我院重症医学科2014-10-2015-12收治SAP患者40例，随机分为监测组与对照组，两组各20例，监测组予以PiCCO联合ScvO2监测，根据全心舒张末容积（GEDI）、血管外肺水（ELWI）、心脏指数（CI）、ScvO2精确补液，其余治疗同对照组，对照组根据SAP治疗指南进行治疗。统计监测组与对照组问血流动力学指标，机械通气率及机械通气时间，血液净化率及CRRT时间，住ICU时间及治疗总费用及28d病死率。结果与对照组比较，第24小时、第48小时监测组血乳酸（mmol／L）较低（2．62±0．51比3．12±0．43，t=3．35，P=0．001；1．42±0．34比1．86±0．75，t=2．39，P=0．022）；氧合指数较高（225．36±45．21比182．28±30．12，t=3．5，P=0．001；288．34±113．65比180．94±83．50，t=3．406，P=0．002）；血肌酐（μmol／L）值偏低（68．21±12．9比80．45±15．64，t=2．7，P=0．010；55．48±31．851：L77．12±19．16，t=3．167，P=0．003）；治疗期间机械通气率（％）低（25％比50％，x2=3．956P=0．047）及机械通气时间（d）缩短（6．5±3．0比8．5±2．6，t=2．253，P=0．030）；血液净化率低（10％比40％，x2=4．80，P=0．020）及CRRT时间（d）缩短（18．0±13．5比35．0±17．8，t=3．403，P=0．002）；住ICU时间（d）缩短（9．61±7．8比15．3±8．8，t=2．178，P=0．036）及治疗总费用（万元）低（7．2±4．4比11．5±6．8，t=2．374，P=0．022）、28d病死率比较差异无统计学意义（10％比15％，x2=0．229，P=0．632）。结论通过PiCCO联合ScvO：监测对SAP早期液体精确管理能更好地稳定血流动力学，维护器官功能，缩短机械通气时间、CRRT时间和ICU住院时间，�Objective To explore the clinical significance through precise management of early - stage liquid of severe acute pancreatitis （ SAP ） under the combination of PiCCO and ScvO2 supervision. Method With the prospective randomized study, 40 cases of SAP admitted in ICU of our hospital from October 2014 to December 2015 were selected to be randomly divided into monitor group and control group with 20 cases in each group. The monitor group were supervised under combination of PiCCO with SevO2, precise fluid management according to GEDI, EVLWI, CI and ScvO2. Other treatments were the same as the control group. The control group was treated in accordance with SAP treatment guideline. Collect and record the haemodynamies index between monitor group and control group, mechanical ventilation rate and mechanical ventilation time, blood purifying rate and CRRT time, number of clays staying in ICU and expense, as well as 28 - day death rate. Result Compared to the control group, the monitor group in the 24th hour and 48th hour the lactic acid was low [ （2.62 ±0.51 ）mmol/Lvs. （3.12±0.43）retool/L, t=3.35, P=0.001;1.42±0.34）mmol/Lvs. （1.86±0.75） retool/L, t = 2.39, P = 0. 0221 ; the oxygenation index was high [ （ 225.36 ± 45.21 ） mmoL/L vs. （182.28 ±30.12）, t=3.5, P=0.001;（288.34±113.65） vs. （180.94 ±83.50）, t=3.406, P= 0.002 ] ; the creatinine level was low [ （ 68.21 ± 12.9） mmol/L vs. （ 80.45 ± 15.64 ） μmol/L, t = 2.7, P = 0. 010 ] ;[ （55.48 ± 31.85）μmoL/L vs. （77.12 ± 19.16）μmoL/L, t = 3. 167, P = 0.003 ] ; during the treatment, mechanical ventilation rate was low （25% vs. 50% , X2 =3. 956, P =0.047） and the mechanical ventilation time was shortened [ （6.5 ± 3.0）d vs. （8.5 ± 2.6） d, t = 2. 253, P = 0.030 ]; the blood purifying rate was low （10% vs. 40%, X2 = 4. 80, P = 0. 020）; the CRRT time was shortened [（18.0±13.5） h vs. （35.0±17.8） h, t =3.403, P=0.002]; stay in ICU reduced [（9.61±7.8）dvs. （15.3±8.8）d, t=2.178, P=0.036]

关 键 词：重症急性胰腺炎(SAP) 脉搏指示连续心排血量(PiCCO) 液体管理 中心静脉血氧饱和度(ScvO2) 

分 类 号：R657.51[医药卫生—外科学]