微创心排量监测在脓毒性休克患者早期治疗中的应用及对预后的影响  

Application of minimally invasive cardiac output monitoring in early treatment of patients with septic shock and its influence on prognosis

作　　者：许伟恒 张雪萌 文海燕[1] 刘冬辉 XU Wei-heng;ZHANG Xue-meng;WEN Hai-yan;LIU Dong-hui(Department of Critical Medicine,Baoding Second Central Hospital,Baoding 072750,Hebei,China)

机构地区：[1]保定市第二中心医院重症医学科,河北保定072750

出　　处：《川北医学院学报》2022年第11期1459-1462,共4页Journal of North Sichuan Medical College

基　　金：河北省保定市科学技术局科研项目(2041ZF220)。

摘　　要：目的:探讨微创心排量监测在脓毒性休克患者早期治疗中的应用及对预后的影响。方法:选取93例脓毒性休克患者为研究对象,根据液体复苏指导方法不同分为对照组(n=47)和观察组(n=46)。对照组患者采用中心静脉压(CVP)监测指导液体复苏;观察组患者采用微创心排量监测指导液体复苏。比较两组患者24 h内液体复苏及预后情况。结果:液体复苏后6 h,观察组患者平均动脉压(MAP)高于对照组(P<0.05),心率(HR)、血乳酸(Lac)低于对照组(P<0.05);液体复苏后24 h,观察组患者Lac低于对照组(P<0.05);观察组患者血管活性药物应用时间、ICU住院时间及机械通气时间短于对照组(P<0.05),补液量少于对照组(P<0.05);两组患者液体复苏后6、24 h中心静脉压(CVP)、血清肌酐(Scr)及28 d内死亡率比较,差异无统计学意义(P>0.05)。结论:微创心排量监测可持续监测脓毒性休克患者心功能变化,协助判断患者病情发展,能更准确指导24 h内液体复苏,改善患者预后。Objective:To explore the application of minimally invasive cardiac output monitoring in the early treatment of patients with septic shock and its effect on prognosis.Methods:A total of 93 patients with septic shock were selected as the research objects, and they were divided into two groups according to their hemodynamic testing methods.47 patients who were instructed by central venous pressure(CVP) for fluid resuscitation were included in the control group, 46 patients who were instructed by minimally invasive cardiac output monitoring were included in the observation group.According to the clinical data of all patients, the fluid resuscitation and prognosis within 24 hours were compared between the two groups.Results:6 h after fluid resuscitation, the MAP of the observation group was higher than that of the control group(P<0.05),the heart rate(HR) and blood lactate(Lac) were lower than those of the control group(P<0.05),and the Lac of the observation group at 24 h after fluid resuscitation was also lower than that of the control group(P<0.05).The duration of vasoactive drug application, ICU stay, and mechanical ventilation in the observation group were shorter than those in the control group(P<0.05),and the fluid replacement volume was less than that in the control group(P<0.05).There was no significant difference in central venous pressure(CVP) and serum creatinine(Scr) between the two groups at 6,24 h after fluid resuscitation and mortality within 28 days(P>0.05).Conclusion:Minimally invasive cardiac output monitoring can continuously detect the changes of cardiac function in patients with septic shock, which can assist in judging the development of the patient’s condition, more accurately guide the fluid resuscitation within 24 hours, and improve the prognosis of the patient.

关 键 词：脓毒性休克 微创心排量监测 24 h内液体复苏 预后 

分 类 号：R459.7[医药卫生—急诊医学]