不同监测方式对严重脓毒血症早期液体复苏相关生化指标影响的检验分析  

Laboratory analysis on influence of different monitoring modes on related biochemical indicators of early fluid resuscitation in severe sepsis

作　　者：娄侠儒 吴翔 黄响玲 陶飞 

机构地区：[1]佛山市禅城区中心医院重症医学科,广东佛山528031

出　　处：《国际检验医学杂志》2018年第1期52-55,共4页International Journal of Laboratory Medicine

基　　金：佛山市卫生和计划生育委员会医学科研课题项目(20160153)

摘　　要：目的探讨经肺温度稀释法(PICCO)监测联合被动抬腿试验(PLR)与中心静脉压(CVP)监测在严重脓毒血症早期液体复苏中的疗效比较。方法选取该院2016年1-12月收治的严重脓毒症患者60例,按照随机数字表法分为治疗组28例与对照组32例。治疗组采用PICCO监测联合PLR,对照组采用CVP监测。比较两组治疗6、24、48、72h血浆钠尿肽(BNP)和血乳酸(LAC)水平变化及血管活性药物停用时间、机械通气时间、重症监护室(ICU)住院时间、多器官功能障碍综合征(MODS)和死亡发生情况。结果治疗组治疗24、48、72h血浆BNP水平低于同期对照组,差异有统计学意义(P<0.05);治疗组治疗24、48、72h血浆LAC水平低于同期对照组,差异有统计学意义(P<0.05);治疗组血管药物停用时间快于对照组,机械通气时间短于对照组,ICU住院时间短于对照组,差异有统计学意义(P<0.05),而两组MODS和病死率比较,差异无统计学意义(P>0.05)。结论 PICCO监测联合PLR在严重脓毒血症早期液体复苏疗效优于CVP监测,具有重要研究意义。Objective To compare the early fluid resuscitation effect of transpulmonary thermodilution(PICCO)monitoring combined with the passive leg raising(PLR)test and central venous pressure(CVP)monitoring in severe sepsis.Methods Sixty patients with severe sepsis admitted in this hospital from January to December 2016 were selected and divided into the treatment group(n=28)and control group(n=32)according to the random number table method.The treatment group adopted PICCO monitoring combined with PLR,while the control group adopted CVP monitoring.The changes of plasma natriuretic peptide(BNP)and blood lactic acid(LAC)levels at 6,24,48,72 hin two groups,time of vasoactive drugs withdrawn,mechanical ventilation time,ICU stay length,and occurrence situation of multiple organ dysfunction syndrome(MODS)and death were compared between the two groups.Results The plasma BNP levels at 24,48,72 hin the treatment group were lower than those in the control group at the same period,the difference was statistically significant(P<0.05);The plasma LAC levels at 24,48,72 hin the treatment group were lower than those in the control group at the same periods,the difference was statistically significant(P<0.05);The vasoactive drug withdrawal time in the treatment group was faster than that in the control group,the mechanical ventilation time was shorter than that in the control group,and the ICU stay time was shorter than that in the control group,the difference was statistically significant(P<0.05);The occurrence rates of MODS and death had no statistical difference between the two groups(P>0.05).Conclusion The PICCO monitoring combined with PLR in severe sepsis has better early fluid resuscitation curative effect than the CVP monitoring and has important study significance.

关 键 词：经肺温度稀释法 抬腿试验 中心静脉压 严重脓毒血症 早期液体复苏 

分 类 号：R459.7[医药卫生—急诊医学]