PiCCO监测指导脓毒症并发急性肾损伤患者容量治疗的效果  

Efficacy of PiCCO monitoring in guiding volume therapy in patients with sepsis complicated with acute kidney injury

作　　者：胡雪珍[1] 龚裕强[2] 孙来芳[1] 孔万权[1] 

机构地区：[1]温州医科大学附属第二医院急诊ICU,325000 [2]温州医科大学附属第二医院综合ICU,325000

出　　处：《中华麻醉学杂志》2018年第3期359-362,共4页Chinese Journal of Anesthesiology

基　　金：浙江省自然科学基金（Y13H150009）

摘　　要：目的评价脉搏指示连续心排血量（PiCCO）监测指导脓毒症并发急性肾损伤患者容量治疗的价值。方法脓毒症并发急性肾损伤患者85例，按是否采用PiCCO监测指导容量治疗，分为PiCCO组（n＝37）和常规组（n＝48）。记录容量治疗6和24 h时血流动力学指标、液体量、血管活性药物用量、肾功能情况及ICU病死情况、28 d病死情况。结果与常规组比较，PiCCO组容量治疗24 h时复苏液体量、容量治疗6和24 h时CVP降低，持续肾脏替代治疗时间缩短，尿量增多，血肌酐水平下降，ICU病死率、28 d病死率明显降低（P〈0.05）。结论对脓毒症合并急性肾损伤患者而言，采用PiCCO监测可合理地指导容量治疗，有助于改善预后。Objective To evaluate the efficacy of pulse indicator continuous cardiac output （PiCCO） monitoring in guiding volume therapy in patients with sepsis complicated with acute kidney injury.Methods Eighty-five patients with sepsis complicated with acute kidney injury were divided into PiCCO group （n=37） and routine group （n=48） according to whether PiCCO monitoring was used to guide volume therapy.The hemodynamic parameters at 6 and 24 h after volume therapy, fluid volume, consumption of vasoactive drugs, renal function, fatality in intensive care unit and 28-day fatality were recorded.Results Compared with routine group, the volume of fluid for resuscitation at 24 h after volume therapy, and central venous pressure were significantly decreased （P〈0.05）, the time of continuous renal replacement therapy was shortened, the urine volume was increased, the blood creatinine level was decreased, and the fatality rate in intensive care unit and 28-day fatality rate were decreased in group PiCCO （P〈0.05）.Conclusion For the patients with sepsis complicated with acute kidney injury, PiCCO monitoring can reasonably guide volume therapy and is helpful in improving the prognosis.

关 键 词：心排血量 导管术 Swan—Ganz 监测 生理学 脓毒症 补液疗法 急性肾损伤 

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