PiCCO指导重症腹腔感染患者液体复苏及预后的影响因素分析  

Effectiveness of plus-indicated continuous cardiac output monitoring technology-guided fluid resuscitation in patients with severe intra-abdominal infection and analysis on factors influencing prognosis

作　　者：吕文 王进 蒋熙攘 史菲 许士海 单爱军 姚奇 Lyu Wen;Wang Jin;Jiang Xirang;Shi Fei;Xu Shihai;Shan Aijun;Yao Qi(Department of Emergency,Shenzhen People's Hospital(the Second Clinical Medical College,Jinan University,The First Affiliated Hospital,Southern University of Science and Technology),Shenzhen 518020,Guangdong,China;Department of Anorectal Surgery,Shenzhen People's Hospital(the Second Clinical Medical College,Jinan University,The First Affiliated Hospital,Southern University of Science and Technology),Shenzhen 518020,Guangdong,China)

机构地区：[1]深圳市人民医院(暨南大学第二临床医学院,南方科技大学第一附属医院)急诊中心,广东深圳518020 [2]深圳市人民医院(暨南大学第二临床医学院,南方科技大学第一附属医院)肛肠外科,广东深圳518020

出　　处：《中国中西医结合急救杂志》2022年第5期554-559,共6页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：广东省深圳市医药卫生科研项目(SZFZ2018022)。

摘　　要：目的观察脉搏指示连续心排量(PiCCO)监测技术在严重腹腔感染(sIAI)液体复苏中的应用效果及对预后的影响。方法采用回顾性队列前后对照研究方法。选择2015年1月至2021年12月深圳市人民医院急诊重症监护病房(EICU)收治的sIAI患者作为研究对象。按是否使用PiCCO指导液体复苏将患者分为PiCCO组和对照组。收集患者的基线资料,包括性别、年龄、体质量、主要诊断、生命体征、休克指数、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评分、白细胞计数(WBC)、血红蛋白(Hb)、血乳酸(Lac)、血肌酐(SCr)、降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)、氧合指数、中心静脉压(CVP)、是否接受手术治疗、是否行机械通气。主要研究结局指标为28 d全因死亡,其他结局指标还包括救治期间急性呼吸窘迫综合征(ARDS)发生率、新增机械通气率、机械通气时间、血管活性药物使用率、血管活性药物使用时间、72 h休克指数降幅、72 h氧合指数增幅、72 h Lac降幅、血液透析使用率、血液透析时间、恢复排气时间、重症监护病房(ICU)住院时间和ICU住院费用,以及治疗过程监测的各项生理生化指标。比较两组基线资料和结局指标的差异,采用单因素和多因素Logistic回归分析影响sIAI患者28 d预后的危险因素;采用重复测量方差分析比较两组治疗前后生理、生化及炎症指标的差异。结果与对照组比较,PiCCO组收缩压明显升高〔mmHg(1 mmHg≈0.133 kPa):91.9±5.9比80.9±4.7〕,而APACHEⅡ、Lac、hs-CRP、CVP、28 d病死率、ARDS发生率、新增机械通气率、机械通气时间、血管活性药使用率和使用时间、血液透析时间、ICU住院时间、ICU住院费用均明显降低〔APACHEⅡ评分(分):18.5±3.2比20.1±3.2,Lac(mmol/L):4.0±1.5比4.7±1.3,hs-CRP(mg/L):230.2±26.0比251.9±39.4,CVP(cmH_(2)O,1 cmH_(2)O≈0.098 kPa):4.8±1.0比5.1±1.0,28 d病死率:20.0%(22/110)比33.1%(40/121),ARDS�Objective To investigate the application effects of the guidance of pulse-indicated continuous cardiac output(PiCCO)monitoring technology on the fluid resuscitation in patients with severe intra-abdominal infection(sIAI)and its influence on prognosis.Methods A retrospective cohort study method was conducted.The sIAI patients admitted to department of emergency intensive care unit(EICU)of Shenzhen People's Hospital from January 2015 to December 2021 were selected as the study subjects.The patients were divided into a PiCCO group and a control group according to whether using PiCCO to guide fluid resuscitation or not.The patients'baseline characteristics,including gender,age,weight,main diagnosis,vital signs,shock index,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,white blood cell count(WBC),hemoglobin(Hb),blood lactic acid(Lac),serum creatinine(SCr),procalcitonin(PCT),hypersensitivit C-reactive protein(hs-CRP),oxygenation index,central venous pressure(CVP),surgical intervention or mechanical ventilation(MV)applied or not were collected.The primary research outcome index was 28-day all-cause mortality,secondary outcome indexes included the incidence of acute respiratory distress syndrome(ARDS),the rate of using the need of MV,the duration of using MV,the rate of using vasoactive drugs,the duration of using vasoactive drugs,72 hours shock index decrease amplitude,72 hours oxygenation index increase amplitude,72 hours Lac decrease amplitude,the rate of using hemodialysis,the duration of using hemodialysis,time of recovery of flatus,length of stay(LOS)in intensive care unit(ICU),and ICU stay costs.Moreover,physiological and biochemical indicators during treatment were also included.The differences in baseline data and outcome indexes were compared between the two groups,and the univariate and multivariate Logistic regression analyses were used to analyze the risk factors affecting the sIAI patients'28-day outcomes;the repeated measuring variance analysis was used to compare the differences between

关 键 词：脉搏指示连续心排量监测 腹腔感染 液体复苏 预后 

分 类 号：R47[医药卫生—护理学]