脉搏指示连续心排血量监测下液体复苏对创伤性休克患者内皮功能、炎性指标和血流动力学的影响  

Effects of fluid resuscitation under pulse-indicated continuous cardiac output monitoring on endothelial function,inflammatory indexes and hemodynamics in patients with traumatic shock

作　　者：汪波 金水芳[2] Wang Bo;Jin Shuifang(Department of Emergency Internal Medicine,the First Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou 310006,Zhejiang Province,China;Department of Critical Care Medicine,the First Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou 310006,Zhejiang Province,China)

机构地区：[1]浙江中医药大学附属第一医院急诊内科,杭州310006 [2]浙江中医药大学附属第一医院重症医学科,杭州310006

出　　处：《中国基层医药》2021年第8期1121-1125,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的:探讨脉搏指示连续心排血量(PICCO)监测下液体复苏对创伤性休克患者血管内皮功能、炎性指标和血流动力学的影响。方法:回顾性分析2019年7月至2020年7月浙江中医药大学附属第一医院收治的创伤性休克患者62例的临床资料,按照液体复苏方法不同分为观察组和对照组各31例。对照组给予常规液体复苏,观察组在PICCO监测下指导液体复苏。比较两组一般治疗情况、治疗前及治疗24 h一氧化氮(NO)、内皮素-1(ET-1)、C反应蛋白(CRP)、白细胞介素(IL)6、IL-1β、肿瘤坏死因子(TNF)α、中心静脉压(CVP)、平均动脉压(MAP)、中心静脉血氧饱和度(ScvO_(2))的变化及并发症发生情况。 结果:观察组达到早期复苏目标时间、机械通气时间、重症监护病房(ICU)留置时间、住院时间分别为(5.33±0.51)h、(37.45±4.84)h、(8.75±1.20)d、(16.85±2.03)d,均明显短于对照组的(8.14±1.20)h、(46.06±4.71)h、(11.46±1.63)d、(20.01±2.41)d,差异均有统计学意义( t=11.999、7.098、7.455、5.584,均 P<0.001);治疗24 h,观察组血清NO为(52.04±3.91)μmol/L,明显高于对照组的(40.25±4.25)μmol/L,血清ET-1为(66.95±4.75)ng/L,明显低于对照组的(78.04±7.92)ng/L,差异均有统计学意义( t=11.367、6.686,均 P<0.001);观察组血清CRP、IL-6、IL-1β、TNF-α分别为(8.32±1.56)mg/L、(113.03±15.74)ng/L、(69.82±6.50)ng/L、(42.80±4.32)ng/L,均明显低于对照组的(11.61±1.74)mg/L、(130.42±20.68)ng/L、(81.33±7.30)ng/L、(56.11±6.36)ng/L,差异均有统计学意义( t=7.838、3.726、6.556、9.639,均 P<0.001);观察组MAP、CVP、ScvO_(2)分别为(76.64±5.05)mmHg、(10.79±0.53)mmHg、(79.93±5.04)%,均明显高于对照组的(70.32±4.31)mmHg、(9.50±0.62)mmHg、(73.40±4.76)%,差异均有统计学意义(t=5.300、8.806、5.245,均 P<0.001);观察组并发症发生率为9.68%(3/31),明显低于对照组的32.26%(10/31),差异有统计学意义(χ^(2)=4.769, P<0.05)。 结论:PICCO监测下进行液体复苏Objective To investigate the effects of fluid resuscitation under pulse-indicated continuous cardiac output monitoring on endothelial function,inflammatory indexes and hemodynamics in patients with traumatic shock.Methods The clinical data of 62 patients with traumatic shock who received treatment in the First Affiliated Hospital of Zhejiang Chinese Medical University,China between July 2019 and July 2020 were retrospectively analyzed.These patients were divided into observation and control groups(n=31/group)according to different fluid resuscitation methods.The control group was given conventional fluid resuscitation and the observation group was subjected to guided fluid resuscitation under pulse-indicated continuous cardiac output monitoring.General treatment and nitric oxide,endothelin^(-1),C-reactive protein,interleukin-6,interleukin^(-1)β,tumor necrosis factor-α,central venous pressure,mean arterial pressure,and central venous oxygen saturation before and 24 hours after treatment as well as complications were compared between the two groups.Results Time to early resuscitation,duration of mechanical ventilation,intensive care unit length of stay and the length of hospital stay in the observation group were(5.33±0.51)hours,(37.45±4.84)hours,(8.75±1.20)days,(16.85±2.03)days,respectively,which were significantly shorter than those in the control group[(8.14±1.20)hours,(46.06±4.71)hours,(11.46±1.63)days,(20.01±2.41)days,t=11.999,7.098,7.455,5.584,all P<0.01).At 24 hours after treatment,serum level of nitric oxide in the observation group was significantly higher than that in the control group[(52.04±3.91)μmol/L vs.(40.25±4.25)μmol/L,t=11.367,P<0.01].Serum level of endothelin^(-1) in the observation group was significantly lower than that in the control group[(66.95±4.75)ng/L vs.(78.04±7.92)ng/L,t=6.686,P<0.01)].Serum levels of C-reactive protein,interleukin-6,interleukin^(-1)β,tumor necrosis factor-αin the observation group were(8.32±1.56)mg/L,(113.03±15.74)ng/L,(69.82±6.50)ng/L,(42.80±4.32

关 键 词：休克 创伤性 脉搏 每搏输出量 复苏术 内皮 血管 炎症介导素类 血流动力学 疗效比较研究 

分 类 号：R605.971[医药卫生—急诊医学]