PiCCO监测下的目标导向集束化治疗脓毒性休克的疗效及相关血流动力学指标对预后的诊断价值  

Effect of goal-directed therapy under PiCCO monitoring on septic shock and the diagnostic value of related hemodynamic indexes for prognosis

作　　者：张灯亮 何先弟[2] 刘杰[1] 解悍东 王辉[1] 李想[1] Zhang Deng-liang;He Xian-di;Liu Jie;Jie Han-dong;Wang Hui;Li Xiang(Anhui Provincial Hospital,the First Affiliated Hospital of Unirersity of Science and Technology of China,Hefei 20000,China)

机构地区：[1]中国科学技术大学附属第一医院安徽省立医院,安徽合肥230000 [2]蚌埠医学院第一附属医院重症医学科,安徽蚌埠233000 [3]安徽省阜阳市第六人民医院重症医学科,安徽阜阳236000

出　　处：《中国急救医学》2020年第6期536-541,共6页Chinese Journal of Critical Care Medicine

基　　金：2016年度阜阳市卫生计生系统科研立项课题。

摘　　要：目的探讨脉搏指示连续心排血量(PiCCO)监测下的目标导向集束化治疗脓毒性休克的疗效以及相关血流动力学指标对预后的诊断价值.方法选取我院2017年10月至2019年9月收治的113例脓毒性休克患者,采用随机数字表法分为观察组57例和对照组56例,观察组采用PiCCO监测下的目标导向集束化治疗方法;对照组采用传统集束化治疗方法.对比两组治疗前后APACHEⅡ评分、SOFA评分、氧合指数(OI)、乳酸清除率、平均动脉压(MAP)、中心静脉压(CVP)、降钙素原(PCT)、胱抑素C(Cys C)、β2微球蛋白(β2-MG)水平变化.观察两组机械通气时间、留置ICU时间以及28 d病死率.根据28 d内是否存活将观察组分为存活组和死亡组,比较两组心脏指数(CI)、中心静脉压(CVP)、每搏指数(SVI)、平均动脉压(MAP)、全心射血分数(GEF)、胸腔内血容积指数(ITBVI)、血管外肺水指数(EVLWI)、外周血管阻力指数(SVRI)、肺毛细血管通透性指数(PVPI)、PCT、血乳酸(Lac).分析相关血流动力学指标和感染指标对脓毒性休克预后的诊断价值.结果治疗6 h和48 h,两组患者APACHEⅡ和SOFA评分均低于治疗前,OI均高于治疗前,且同期观察组APACHEⅡ和SOFA评分均低于对照组,OI高于对照组(P<0.05);治疗48 h,两组患者乳酸清除率均高于治疗6 h,液体复苏量均低于治疗6 h,且同期观察组乳酸清除率高于对照组,液体复苏量低于对照组(P<0.05);治疗6 h和48 h,两组患者MAP、CVP均高于治疗前,PCT、Cys C、β2-MG均低于治疗前,但两组同期比较,此5项指标比较差异无统计学意义(P>0.05).观察组机械通气时间、留置ICU时间及28 d病死率均低于对照组(P<0.05).观察组中,存活组CI、MAP高于死亡组(P<0.05),EVLWI、PVPI、PCT、Lac低于死亡组(P<0.05),两组SVI、SVRI、GEF、ITBVI比较差异无统计学意义(P>0.05).CI、MAP、EVLWL、PVPI、PCT、Lac对脓毒性休克预后诊断价值曲线下面积分别为0.648、0.653、0.673、0Objective To explore the efet of goal-dreted therapy under the momitoring of pulse indicating ounioos cardiac oulput(PiCCO)and the dingoatie value of related hemodynamic indexes for the prugnoesis of septie shuck.Methods 113 patients with septie shock admitted to our boepital from October 2017 to Sepember 2019 were dirided into the obervation group(n=57) and the contol group(n=56)by random number table mebod.The observation group Wwas treated with goul-directed therapy under the monitoring of PICCO and the control group was treiated with traditional eluster therapy.The change of APACHE Ⅱ score,SOFA score,OI,lactale elearance,MAP,CVP,PCT,Cys C and β2-MG were compared before and after treatment.The mechanical ventilation time,ICU time and 28-day mortality of the two groups were observed.Aeccording to whether survired or not within 28 days,the observation group was divided into the surviral group and the death group.The CI,CVP,SVI,MAP,GEF,ITBVI,EVLWI,SVRI,PVPI,PCT,Lae were compred between the two groups.The diagnostie value of hemodynanie indexes and infectio indexes in the prognosis of septic sbock was analyzed.Results After 6-hour and 48-hour treatment,the APACHE Ⅱ and SOFA scores of the two groups werr lower than thoee before treatment,and the 01 was higher than that before treatment,at the same time,APACHE Ⅱ and SOFA score8 in the obeervation group were lower than those in the control group,and 01 was higher than that in the control group(P<0.05).After 48-hour treatment,laetate clearance ratle of the tmo groupe W8s higher than that after treatment,and the volume of fluid resuscitation was lower than that after 6 hours of treatment,at the same time,the lactate clearance male of the olbservation group was higher than that of the control group,and the volume of fluid resuseitation was lower than that of the control goup(P<0.05).Afer 6-hour and 48-hour treatment,MAP and CVP of the two groupe were higher than those before treatment,PCT,Cye C and β2-MG were lower tham those before treaiment,bu thee were no sig

关 键 词：脉搏指示连续心排血量 脓毒性休克 血流动力学 疗效 预后 

分 类 号：R459.7[医药卫生—急诊医学]