PICCO监测下脓毒症休克患者复苏实施时间与预后的关系  

Relationship between fluid resuscitation under PICCO in different time and the prognosis of patients with septic shock

作　　者：韩沙沙[1] 翟乃亮[1] 许玲[1] 田焕焕[1] HAN Shasha;ZHAI Nailiang;XU Ling;TIAN Huanhuan(Department of Respiratory and Critical ICU,Binzhou Medical University Hospital,Binzhou 256603,P.R.China)

机构地区：[1]滨州医学院附属医院呼吸与重症医学科

出　　处：《滨州医学院学报》2019年第4期295-297,共3页Journal of Binzhou Medical University

摘　　要：目的观察并评估脓毒症休克患者在脉搏指示连续心排血量(PICCO)监测指导下实施液体复苏的不同达标时间对预后的影响。方法采用回顾性研究的方法,根据PICCO监测的指标即胸腔内血容量指数达到850~1 000 mL/m^ 2时间的不同分为0~6 h达标组和6~12 h达标组。记录两组患者入院后6 h、12 h、24 h和48 h的血气分析、乳酸、感染相关的器官衰竭评分(即SOFA评分)、ICU住院天数、带机时间等,并记录7天、28天病死率。结果治疗24 h后0~6 h达标组乳酸及SOFA评分明显低于6~12 h达标组,并且28天病死率明显降低。0~6 h达标组患者较6~12 h达标组的带机时间缩短、ICU住院天数减少,7天病死率有所减少,但差异无统计学意义。两组患者治疗后的氧合指数、乳酸等指标均较入院时好转。结论在PICCO监测指导下对脓毒症休克患者实施液体复苏治疗,6 h达标较12 h达标可明显降低SOFA评分及28天病死率。6 h与12 h使ITBVI达到850~1 000 mL/m^ 2均可改善患者预后。Objective To observe and evaluate the effect of different fluid resuscitationstandard time on the prognosis of patients with septic shock under the guidance of PICCO monitoring.Methods A retrospective study was used.The patients divided into 0~6 h standard group and 6~12 h standard group according to the different time when ITBVI reached 850~1 000mL/m^2 monitored by PICCO.Blood gas analysis,lactic acid,SOFA scorewere recorded at 6 h,12 h,24 h and 48 h after admission,length of stay in ICU,mechanical ventilation time,and the fatality rate at 7 and 28 days were recorded.Results After 24 h of treatment,lactic acid and SOFA scores in the 0~6 h group were significantly lower than those in the 6~12 h group,and the fatality rate was significantly reduced at 28 days.Compared with the 6~12 h standard group,patients in the 0~6 h standard group had shorter mechanical ventilation time,shorter time in ICU,and less 7-day mortality,but the difference was not statistically significant.After treatment,the indexes of oxygenation index and lactic acid in both groups were better than those at 0 h.Conclusion Fluid resuscitation therapy for patients with septic shock under the guidance of PICCO monitoring can significantly reduce SOFA score and 28-day mortality after reaching the standard at 6 h compared with 12h.Both 6 h and 12 h ITBVI reaching 850~1 000 mL/m^2 can improve the prognosis of patients.

关 键 词：脓毒症休克 脉搏指示连续心排血量 胸腔内血容量指数 液体复苏 

分 类 号：R459.7[医药卫生—急诊医学]