PiCCO监测下连续血液净化对脓毒性心肌病心肌保护疗效观察  

Observation on the therapeutic effect of continuous blood purification under PiCCO monitoring on myocardial protection in septic cardiomyopathy

作　　者：张辉 曹莉 李明[1] Zhang Hui;Cao Li;Li Ming(Department of Critical Care Medicine,Shiyan People's Hospital,Baoan District,China)

机构地区：[1]深圳市宝安区石岩人民医院重症医学科

出　　处：《实用休克杂志（中英文）》2023年第6期351-353,372,共4页Journal of Practical Shock

基　　金：深圳市宝安区科技计划项目(项目编号:No20200430172044779)。

摘　　要：目的探讨脉搏指示连续心输出量(PiCCO)监测下连续血液净化在脓毒性心肌病患者心肌保护的效果。方法选择2021年5月至2023年3月脓毒性心肌病患者90例为对象,根据病情严重程度结合治疗指南分为两组。对照组38例采用常规方法联合PiCCO监测干预,观察组52例联合血液净化治疗,两组治疗2周后评估患者效果,比较两组血流动力学、炎性因子、心肌指标、安全性及死亡率。结果两组干预2周后血流动力学降低;观察组CO、GEDV、EVLW、SV及CI高于对照组(P<0.05);观察组干预2周后TNF-α、IL-6、NT-proBNP、cTnI含量低于对照组(P<0.05);两组干预过程中肝肾损伤、过敏反应、腹泻便秘及恶心呕吐发生率无统计差异(P>0.05);观察组死亡率低于对照组(P<0.05)。结论PiCCO监测下连续血液净化用于脓毒性心肌病患者中,能改善血流动力学水平,可降低炎性因子,实现心肌保护作用,且治疗安全性较高,有助于降低患者死亡率,值得推广应用。Objective To explore the effect of continuous blood purification under pulse indicating continuous cardiac output(PiCCO)monitoring on myocardial protection in patients with septic cardiomyopathy.Methods 90 patients with septic cardiomyopathy from May 2021 to March 2023 were selected as the study subjects,and were divided into two groups based on the severity of the condition and treatment guidelines.The control group of 38 cases was treated with conventional methods combined with PiCCO monitoring intervention,while the observation group of 52 cases was treated with blood purification.After 2 weeks of treatment,the patient's efficacy was evaluated,and hemodynamics,inflammatory factors,myocardial indicators,safety,and mortality were compared between the two groups.Results After 2 weeks of intervention,hemodynamics decreased in both groups;The CO,GEDV,EVLW,SV and CI in the observation group were higher than those in the control group(P<0.05);TNF after 2 weeks of intervention in the observation group-α,the levels of IL-6,NT-proBNP,and cTnI in the control group were lower than those in the control group(P<0.05);There was no statistical difference in the incidence of liver and kidney damage,allergic reactions,diarrhea,constipation,and nausea and vomiting between the two groups during the intervention process(P>0.05);The mortality rate in the observation group was lower than that in the control group(P<0.05).Conclusions Continuous blood purification under PiCCO monitoring can improve hemodynamic levels,reduce inflammatory factors,and achieve myocardial protection in patients with septic cardiomyopathy.The treatment safety is high,which helps to reduce patient mortality and is worthy of promotion and application.

关 键 词：脉搏指示连续心输出量 连续血液净化 脓毒性心肌病 心肌保护 炎性因子 

分 类 号：R459.7[医药卫生—急诊医学]