重症急性胰腺炎PICCO联合膀胱内压监测指导下的液体复苏对患者疗效及预后的影响  

Effects of fluid resuscitation guided bypulse indicator continuous cardiac output monitoring combined with urinary bladder pressure inspection on the prognosis of severe acute pancreatitis

作　　者：邓超[1] 管军 苏醒 符均 DENG Chao;GUAN Jun;SU Xing;FU Jun(Department of Critical Care Medicine,Haikou Hospital Affiliated to Central South University Xiangya School of Medicine,Haikou Hainan 570208,China)

机构地区：[1]中南大学湘雅医学院附属海口医院重症医学科,海南海口570208

出　　处：《中国急救复苏与灾害医学杂志》2022年第6期785-789,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：海南省医药卫生科研项目(编号:20A200509)。

摘　　要：目的研究脉搏指数连续心排血量(PICCO)联合膀胱内压监测在指导重症急性胰腺炎(SAP)液体复苏中的疗效及对患者预后的影响。方法将医院2019年7月—2020年12月间收治的93例SAP患者纳为研究对象,采用随机数字表法将其均分为对照组、PICCO组及联合组,三组均31例。其中对照组在常规临床指标决策下进行液体复苏,PICCO组在PICCO监测下进行液体复苏,而联合组在PICCO联合膀胱内压监测下进行液体复苏。比较三组器官衰竭率、液体复苏总量、去甲肾上腺素用量、血流动力学及血气分析相关指标,并统计三组患者预后,分析PICCO联合膀胱内压监测在指导SAP体液复苏中的疗效。结果联合组与PICCO组机械通气时间、ICU住院时间以及血管活性药物使用时间均显著短于对照组(P<0.05),此外,联合组械通气时间、ICU住院时间以及血管活性药物使用时间均显著短于PICCO组(P<0.05)。液体复苏干预1 d后,三组患者平均动脉压(MAP)及中心静脉压(CVP)水平均较同组治疗前显著升高(P<0.05),心率(HR)水平均较同组治疗前显著下降(P<0.05);且联合组及PICCO组治疗1 d后,其MAP及CVP水平显著低于对照组(P<0.05)。治疗1 d后,三组PaO_(2)、PaO_(2)/FiO_(2)水平均较同组治疗前均下降,其中对照组治疗后,PaO_(2)、PaO_(2)/FiO_(2)水平显著下降(P<0.05),联合组及PICCO组治疗1 d后,两指标水平与治疗前无统计学差异(P>0.05),且均高于对照组治疗后(P<0.05)。对照组治疗1d后,PaCO_(2)水平无明显改善(P>0.05),PICCO组及联合组治疗1 d后,PaCO_(2)水平显著升高(P<0.05),且均显著高于对照组(P<0.05),其中联合组治疗1d后PaCO_(2)水平基本恢复正常水平,且显著高于PICCO组(P<0.05)。三组治疗后,乳酸水平均显著降低(P<0.05),且联合组及PICCO组治疗1d后乳酸水平显著低于对照组(P<0.05),联合组又显著低于PICCO组(P<0.05)。治疗后,联合组及PICCO组乳酸清除率显著高于对照组(P<0.Objective To investigate the effects of fluid resuscitation under the guidance of pulse indicators continuous cardiac output(PICCO)monitoring combined with urinary bladder pressure inspection on prognosis of severe acute pancreatitis(SAP).Methods Ninety-three patients with SAP were randomly divided into three equal groupsreceiving fluid resuscitation:control group guided by routine indicators,PICCO group guided by PICCO monitoring,and combination group guided by PICCO combined with urinary bladder pressure inspection.The organ failure rate,total volume of fluid resuscitation,norepinephrine dosage,hemodynamics,and blood gas analysis were compared among the three groups.The prognosis of the three groups was recorded,then the value of PICCO monitoring combined with urinary bladder pressure inspection in fluid resuscitation for SAP patients was evaluated.Results The mechanical ventilation time,ICU stay length and duration of vasoactive drug administration of the combination group were the shortest,followed by the PICCO group,and were the longest in the control group,with statistical difference(P<0.05).After 1 d of fluid resuscitation intervention,the mean arterial pressure(MAP)and central venous pressure(CVP)were significantly increased,and the heart rate(HR)was significantly decreased in all three groups(all P<0.05),meantime,the values of MAP and CVA of the combination group and PICCO group were significantly lower than those of the control group(all P<0.05).There was a decrease in arterial oxygen partial pressure(PaO_(2))and ratio of arterial oxygen partial pressure to fraction of inspiration O_(2)(PaO_(2)/FiO_(2))in all three groups after 1 d of fluid resuscitation intervention,and the decrease was the most significant in the control group(P<0.05),while the decrease showed no statistical difference between the PICCO group and combination group(P>0.05),and the PaO_(2) and PaO_(2)/FiO_(2) levels after 1 d of fluid resuscitation intervention were significantly higher in the PICCO group and combination group than in t

关 键 词：重症急性胰腺炎 脉搏指数连续心排血量 膀胱内压监测 液体复苏 预后 

分 类 号：R657.51[医药卫生—外科学]