早期血流动力学监测在泌尿系统钬激光碎石术后并发脓毒性休克患者救治中的价值探讨  

Value of early hemodynamic monitoring in patients complicated with septic shock after holmium laser lithotripsy of urinary system

作　　者：范晶[1] 张苜[1] 黄彪 余应喜[1] Fan Jing;Zhang Mu;Huang Biao;Yu Yingxi(Department of Intensive Care Unit,The First Affiliated Hospital of Chongqing Medical University;Department of Intensive Care Unit,The People’s Hospital of Dazu District Chongqing)

机构地区：[1]重庆医科大学附属第一医院重症医学科,重庆400016 [2]重庆市大足区人民医院重症医学科,重庆402360

出　　处：《重庆医科大学学报》2020年第5期589-594,共6页Journal of Chongqing Medical University

基　　金：重庆市科委技术创新与应用发展资助项目(编号:cstc2019jscx-msxm0426);重庆市卫计委医学科研计划资助项目(编号:2017MSXM017、2017MSXM184)。

摘　　要：目的:探讨早期血流动力学监测在泌尿系统钬激光碎石术后并发脓毒性休克救治中的价值。方法:回顾性分析2013年1月至2018年12月入住重庆医科大学附属第一医院重症医学科的37例泌尿道钬激光碎石术后并发脓毒性休克的患者临床资料,根据是否在脉博指示连续心排血量监测(pulse index continuous cardiac output,PiCCO)下进行液体复苏,分为PiCCO监测组及非PiCCO监测组,分别对一般资料和治疗前病情严重程度指标,对治疗前后PiCCO监测相关指标,以及对2组患者治疗6 h、24 h相关临床指标进行比较。结果:PiCCO监测组患者治疗后6 h,全心舒张末期容积指数(global end diastolic volume index,GEDI)、心指数(cardiac index,CI)、血管外肺水指数(external lung water index,EVLWI)、全身血管阻力指数(systemic vascular resistance index,SVRI)、平均动脉压(mean arterial pressure,MAP)较治疗前增加(Z值分别为-3.393、-4.059、-4.189、-3.241、-3.736;P值分别为0.005、0.000、0.000、0.001、0.000),治疗后24 h的GEDI、CI、SVRI较治疗后6 h进一步增加(Z值分别为-3.751、-2.738、-4.749;P值分别为0.000、0.006、0.000)。治疗6 h后PiCCO监测组较非PiCCO监测组血乳酸值、去甲肾上腺素用量低(Z值分别为-2.070、-3.895;P值分别为0.038、0.000);治疗6 h和治疗24 h后PiCCO监测组氧合指数(PO2/FiO2)及每小时尿量均较非PiCCO监测组增加(治疗6 h的Z值分别为-2.499、-3.314,P值分别为0.012、0.001;治疗24 h的Z值分别为-3.833、-3.466;P值分别为0.000、0.001);PiCCO监测组晶体液总量、胶体液总量治疗6 h后较非PiCCO监测组增加(Z值分别为-4.845、-4.401;P值分别为0.000、0.000),而治疗24 h后较非PiCCO监测组减少(Z值分别为-2.338、-2.948;P值分别为0.019、0.003)。治疗后,PiCCO监测组患者机械通气时间较非PiCCO监测组降低、ICU停留时间缩短(Z值分别为-2.195、-2.173;P值分别为0.028、0.030)。以上结果表明PiCCO监测组在早期液体Objective:To explore the value of early hemodynamic monitoring in patients complicated with septic shock patients after holmium laser lithotripsy of urinary system.Methods:Clinical data of 37 patients with septic shock after holmium laser lithotripsy of urinary tract who were admitted to our department of The First Affiliated Hospital of Chongqing Medical University from January 2013 to December 2018 were retrospectively analyzed.According to the liquid resuscitation under pulse index continuous cardiac output(PiCCO),those patients were divided into the PiCCO monitoring group and the non-PiCCO monitoring group.General information,pre-treatment indicators of disease severity,pre-and-post-treatment PiCCO monitoring indicators and clinical indicators after treatment of 6h and 24 h in two groups were respectively analyzed.Results:After treatment of 6h,global end diastolic volume index(GEDI),cardiac index(CI),external lung water index(EVLWI),systemic vascular resistance index(SVRI)and mean arterial pressure(MAP)in the PiCCO monitoring group were increased when compared with those before treatment(Z:-3.393,-4.059,-4.189,-3.241,-3.736;P:0.005,0.000,0.000,0.001,0.000);after treatment of 24 h,GEDI,CI and SVRI were higher than those after treatment of 6 h(Z:-3.751,-2.738,-4.749;P:0.000,0.006,0.000).After treatment of 6 h,levels of blood lactic acid and norepinephrine in the PiCCO monitoring group were lower than those in the PiCCO monitoring group(Z:-2.070,-3.895;P:0.038,0.000);after treatment of 6 h and 24 h,oxygenation index(PO2/FiO2)and urine volume per hour in the PiCCO monitoring group were higher than those in the non-PiCCO monitoring group(Z after treatment of 6 h:-2.499,-3.314;P:0.012,0.001;Z after treatment of 24 h:-3.833,-3.466;P:0.000,0.001);after treatment of 6 h,the total amount of crystalline liquid and colloidal fluid in the PiCCO monitoring group were increased when compared with those in the non-PiCCO monitoring group(Z:-4.845,-4.401;P:0.000,0.000);after treatment of 24 h,the total amount of crystalline li

关 键 词：血流动力学监测 碎石术 脓毒性休克 液体复苏 

分 类 号：R631[医药卫生—外科学]