PICCO与CVP技术在重症感染患者中的应用效果比较  

Comparative study on the application of PICCO and CVP technologies in severe infection patients

作　　者：邓利艳 张德春 杨斌 黄伟 谭仁杰 冉国敬 Deng Liyan;Zhang Dechun;Yang Bin;Huang Wei;Tan Renjie;Ran Guojing(Department of Intensive Care Medicine,Chongqing Three Gorges Medical College Affiliated People's Hospital,Chongqing 404000,China)

机构地区：[1]重庆三峡医药高等专科学校附属人民医院重症医学科,重庆404000

出　　处：《保健医学研究与实践》2024年第6期55-60,共6页Health Medicine Research and Practice

基　　金：重庆市教委科学技术研究项目(KJQN202202720)。

摘　　要：目的探讨脉搏指示连续心排血量(PICCO)与中心静脉压(CVP)技术在重症感染患者中的应用效果,以期为重症感染患者治疗方案的选择提供参考。方法选取2021年1—12月在重庆三峡医药高等专科学校附属人民医院重症监护病房(ICU)采用CVP技术进行监测的35例重症感染患者作为对照组,另选取2022年1月—2023年8月在医院ICU采用PICCO技术进行监测的34例重症感染患者作为研究组。2组患者分别依据CVP、PICCO监测情况开展液体复苏治疗。比较2组患者的生理指标、预后状况及治疗30 d内病死率,分析研究组患者血流动力学参数变化情况。结果2组患者心率(HR)、平均动脉压(MAP)、中心静脉血氧饱和度(ScvO2)、CVP及动脉血乳酸(Lac)水平重复测量方差分析的组间、交互效应均无统计学意义(P>0.05);2组患者HR、MAP、ScvO2、CVP及Lac水平重复测量方差分析的时间效应有统计学意义(P<0.05)。治疗前,2组患者HR、MAP、ScvO2、CVP及Lac水平比较,差异均无统计学意义(P>0.05);治疗12 h、2 d、4 d后,2组患者HR、Lac水平均低于治疗前,MAP、ScvO2及CVP水平均高于治疗前,差异均有统计学意义(P<0.05)。研究组患者治疗前及治疗12 h、2 d、4 d后全心舒张末容积指数(GEDVI)、心输出量指数(CI)及血管外肺水指数(EVLWI)水平比较,差异有统计学意义(P<0.05);且随着治疗时间的增加,研究组患者GEDVI、CI水平逐渐上升,EVLWI水平逐渐降低,两两比较差异均有统计学意义(P<0.05)。研究组患者ICU住院时间、机械通气时间及血管活性药物使用时间均短于对照组,差异均有统计学意义(P<0.05);2组患者治疗30 d内病死率比较,差异无统计学意义(P=0.710);Kaplan-Meier生存曲线显示,研究组与对照组患者治疗30 d内总生存率为91.18%和85.71%,差异无统计学意义(χ2=0.559,P=0.455)。结论PICCO与CVP技术均可有效指导重症感染患者的液体复苏治疗,但PICCO技术较CVP技术对改善Objective To compare the application effects of pulse-induced contour cardiac output(PICCO)and central venous pressure(CVP)technologies in severe infection patients,providing a reference for treatment plan selection.Methods A total of 35 severe infection patients monitored by CVP technology in the ICU of our hospital from January to December 2021 were designated as the control group.Another 34 severe infection patients monitored using PICCO technology in the ICU of our hospital from January 2022 to August 2023 were designated as the study group.Both groups underwent fluid resuscitation based on CVP or PICCO monitoring.Physiological indicators,prognosis,and 30-day mortality rates were compared,and hemodynamic parameter changes in the study group were analyzed.Results No statistically significant differences were noted between the two groups in repeated measures analysis of variance for heart rate(HR),mean arterial pressure(MAP),central venous oxygen saturation(ScvO2),CVP,and arterial blood lactate(Lac)in terms of group or interaction effects(P>0.05).However,significant differences were found in the time effect(P<0.05).Before treatment,no significant differences were observed in HR,MAP,ScvO2,CVP,and Lac levels between the two groups(P>0.05).After 12 hours,2 days,and 4 days of treatment,HR and Lac levels in both groups were significantly lower than before treatment,while MAP,ScvO2,and CVP levels were significantly higher than before treatment(P<0.05).In the study group,the general end-diastolic volume index(GEDVI),cardiac index(CI),and extravascular lung water index(EVLWI)showed significant changes before treatment and at 12 hours,2 days,and 4 days post-treatment(P<0.05).With the progression of treatment,GEDVI and CI levels significantly increased,while EVLWI levels significantly decreased in pairwise comparisons(P<0.05).The study group had shorter ICU stay,duration of mechanical ventilation,and vasopressor usage time than the control group,with statistically significant differences(P<0.05).No significant difference

关 键 词：脉搏指示连续心排血量 中心静脉压 重症感染 血流动力学 

分 类 号：R459.7[医药卫生—急诊医学] R639[医药卫生—治疗学]