脉波指数连续心搏量监测在连续肾脏替代疗法治疗脓毒症并发急性呼吸窘迫综合征患者中的临床价值  

Clinical value of PICCO monitoring in CRRT for sepsis complicated with acute respiratory distress syndrome

作　　者：崔巍[1] 李新[1] 虎琼华[1] 徐治波[1] 

机构地区：[1]成都市第二人民医院,成都610017

出　　处：《内科急危重症杂志》2017年第6期486-489,共4页Journal of Critical Care In Internal Medicine

摘　　要：目的:探讨脉波指数连续心搏量(PICCO)监测对连续肾脏替代疗法(CRRT)治疗脓毒症并发急性呼吸窘迫综合征(ARDS)患者时临床参数调整的指导价值,寻找控制患者血容量更为精确的临床方法。方法:选择接受CRRT治疗的脓毒症并发ARDS患者84例,采用数字随机表法将其分为对照组和观察组,每组42例,对照组采用常规方法对患者的血容量进行调节,观察组患者采用PICCO监测心指数(CI)、舒张末期容积指数(EDVI)及胸腔血容积指数(ITBI)对血容量进行调节。比较2组患者入组前、入组后12、48、96 h的炎症细胞因子(IL-6、IL-8、IL-1β、TNF-α)水平、呼吸功能指标[呼吸频率、氧分压(PaO_2)、氧合指数(PaO_2/FiO_2)、APACHEⅡ评分]及循环功能指标(动脉收缩压、舒张压、心率),统计2组患者机械通气时间、住ICU时间及病死率。结果:2组患者入组前炎症细胞因子水平、呼吸功能及循环功能指标比较差异均无统计学意义(均P>0.05);治疗后12、48、96 h时,2组患者炎症细胞因子(IL-6、IL-8、IL-1β、TNF-α)水平均降低,但观察组患者在48、96 h后均低于对照组(均P<0.05);治疗后12h 2组患者的呼吸频率、APACHEⅡ评分均降低,PaO_2、PaO_2/FiO_2均升高,但观察组呼吸频率、APACHEⅡ评分低于对照组,PaO_2、PaO_2/FiO_2高于对照组(均P<0.05),继续治疗48、96 h后变化不大。治疗后12、48、96 h时2组患者的心率降低,动脉收缩压、舒张压升高,但观察组心率、动脉收缩压、舒张压均低于对照组(均P<0.05)。观察组住ICU时间、机械通气时间及病死率均低于对照组(均P<0.05)。结论:PICCO监测CRRT治疗脓毒症合并ARDS对患者呼吸、循环各指标控制效果更优,患者的预后明显优于常规控制手段,对脓毒症合并ARDS具有较高的临床价值。Objective：To investigate the guiding value of the adjustment of clinical parameters by pulse-index continuous cardiac output（PICCO） in continuous renal replacement therapy（CRRT） for sepsis complicated with acute respiratory distress syndrome（ARDS） in order to find a more accurate clinical method for controlling the volume of blood in patients.Methods：Eighty-four patients with sepsis and ARDS treated with CRRT were randomly divided into control group and observation group by digital random table method,42 cases in each group. In the control group,the blood volume was adjusted by conventional methods,and that in the observation group was adjusted by monitoring cardiac index（CI）,end diastolic volume index（GEDI） and intrathoracic blood volume index（ITBI） with PICCO. The levels of inflammatory cytokines（IL-6,IL-8,IL-1 beta,and TNF-alpha）,respiratory function indexes [respiratory frequency,oxygen partial pressure（PaO_2）,oxygenation index（PaO_2/FiO_2）,APACHE II score] and circulatory function indexes（arterial systolic blood pressure,diastolic blood pressure,heart rate） were compared between two groups before,and 12 h,48 h,96 h after enrollment. Mechanical ventilation time,ICU time and mortality were statistically analyzed in two groups. Results：There was no significant difference in inflammatory cytokine levels,respiratory function indexes and circulatory function indexes between two groups before enrollment（P〈0.05）. At 12 h,48 h and 96 h after treatment,inflammatory cytokines（IL-6,IL-8,IL-1 beta and TNF-alpha） levels were significantly reduced,and those in the observation group at 48 h and 96 h after treatment were significantly lower than in the control group（P〈0.05）. At 12 h after treatment,respiratory rate and APACHE score in two groups were decreased,and PaO_2 and PaO_2/FiO_2 were increased. The respiratory frequency and APACHE score were lower,and PaO_2 and PaO_2/FiO_2 were higher than those in the control group（P〈0.05）. At 48 h and 96 h after tre

关 键 词：脓毒症 急性呼吸窘迫综合征 连续肾脏替代疗法 脉波指数连续心搏量 循环功能 呼吸功能 

分 类 号：R631[医药卫生—外科学] R563[医药卫生—临床医学]