PICCO监测技术联合重症超声在感染性休克患者液体复苏中的应用  

Clinical application of PICCO monitoring technique and critical ultrasonograply for fluid resuscitation in patients with septic shock

作　　者：高洪媛[1] 邹新华[1] 屈峰[1] 高淑红[1] GAO Hong-yuan;ZOU Xin-hua;QU Feng;GAO Shu-hong(ICU,the First People’s Hospital of Jining,Jining,Shandong　272111,China)

机构地区：[1]济宁市第一人民医院,山东济宁272111

出　　处：《临床肺科杂志》2018年第2期315-317,共3页Journal of Clinical Pulmonary Medicine

基　　金：山东省济宁市科技计划项目(No 2013jnwk27)

摘　　要：目的探讨脉搏指示连续心输出量测定(Pi CCO)监测技术联合重症超声,在感染性休克患者液体复苏中应用价值。方法采用前瞻性临床观察研究方法,选取济宁市第一人民医院重症监护病房(ICU)55例感染性休克患者随机分为两组,传统组25例采用Pi CC0监测患者胸腔内血容量指数(intrathoracic blood volume index,ITBVI)、血管外肺水指数(extravascular lung water index,EVLWI)联合中心静脉压(CVP)指导液体复苏。实验组30例采用Pi CC0监测联合重症超声测量下腔静脉变异率指导液体复苏。观察两组患者治疗6h、24h液体复苏效果、液体总入量、机械通气时间、ICU住院时间等指标。结果 1.与传统组比较,实验组在24 h的氧合指数、Sc VO2、血乳酸均有统计学差异(t=-2.507、3.625、-1.768 P<0.05)。2.实验组6h液体总量与传统组无明显差异(t=6.039 P>0.05),但24h液体总量低于传统组(t=4.785 P<0.05)。3.实验组较传统组机械通气时间少,住院时间短,死亡率降低均有统计学意义(P<0.05)。结论感染性休克患者行Pi CCO监测联合重症超声,指导液体复苏,能准确判断血容量状态,降低液体总入量,避免输液过多,有效地改善心肺功能,降低病死率。Objective To evaluate the clinical value of pulse indicated continuous cardiac output(PICCO)and critical ultrasonograply for fluid resuscitation in patients with septic shock.Methods In a prospective study,a total of 55 patients with septic shock admitted to ICU in Jining first people's hospital were enrolled and randomly divided into the traditional group(n=25)and the experimental group(n=30).The experimental group received fluid resuscitation guided by intrathoracic blood volume index(ITBVI),extra vascular lung water index(EVLWI)and critical ultrasound measurement of inferior vena cava monitored by PICCO,while the traditional group received fluid resuscitation guided by PICCO and central venous pressure(CVP).Their 6 h,24 h treatment effect,characteristics of fluid management duration of mechanical ventilation,and duration of ICU stay were compared.Results ①Compared with the traditional group,24-hour oxygenation index,ScVO 2 and blood lactate was significantly lower in the experimental group(t=-2.507,3.625,-1.768,P<0.05).②There was no significant difference in fluid output(m1)in 6h between the two groups(t=6.039,P>0.05),while fluid output(m 2)in 24 hours was significantly lower in the experimental group than the traditional group(t=4.785,P<0.05).③The duration of ICU stay and mechanical ventilation was shorter,and its mortality was lower in the experimental group than in the traditional group(P<0.05).Contusion Fluid resuscitation in patients with septic shock monitored by PICC0 and critical ultrasound can accurately judge liquid capacity,reduce the total amount of liquid,avoid excessive infusion,improve heart and lung function effectively,and reduece mortality.

关 键 词：感染性休克 中心静脉压 胸腔内血容量指数 血管外肺水指数 重症超声 

分 类 号：R459.7[医药卫生—急诊医学]