摘要
目的 探讨脉搏指示剂连续心排量(PICCO)监测、床旁超声监测在感染性休克患者治疗指导中的应用。方法 选择2019年2月-2020年7月重庆市开州区人民医院收治的102例感染性休克患者为研究对象,采用随机数字表法分为PICCO组53例及床旁超声组49例,分别根据PICCO、床旁超声监测情况进行液体管理治疗,比较复苏后血氧参数、心功能指标,统计并发症及预后。结果 PICCO组治疗后心输出量指数(CI)、全心舒张末容积指数(GEDVI)、胸腔内血容积指数(ITBVI)、血管外肺水指数(EVLWI)等血流动力学指标升高,床旁超声组治疗后每搏输出量(SV)、CI、左心室舒张末期容积(LVEDV)升高,下腔静脉扩张指数(dIVC)降低(P<0.05);两组治疗后中心静脉压(CVP)、平均动脉压(MAP)、中心静脉血氧饱和度(ScvO)水平升高(P<0.05),乳酸(Lac)水平降低(P<0.05),PICCO组患者治疗48 h时Lac水平低于床旁超声组(P<0.05);两组治疗后NT-proBNP、心肌肌钙蛋白(cTnI)等心功能标志物指标水平降低(P<0.05),两组组间比较,无统计学差异;两组血管活性药物用量、感染例数、机械通气时间、重症监护室(ICU)治疗时间、30 d内病死例数比较,无统计学差异。结论 PICCO及床旁超声均对感染性休克患者液体复苏有较好的指导作用。
OBJECTIVE To explore the effect of pulse indicator continuous cardiac output(PICCO) monitoring and bedside ultrasound on treatment of patients with septic shock. METHODS A total of 102 patients with septic shock who were treated in Kaizhou District People’s Hospital from Feb 2019 to Jul 2020 were recruited as the study objects and randomly divided into the PICCO group with 53 cases and the bedside ultrasound group with 49 cases. The PICCO group was treated with fluid resuscitation under the guidance of PICCO parameters, while the bedside ultrasound group was treated under the guidance of bedside ultrasound. The blood oxygen parameters and cardiac function indicators were compared after resuscitation, and the complications and treatment outcomes were statistically analyzed. RESULTS The hemodynamics indexes cardiac index(CI), global end diastolic volume index(GEDVI), intrathoracic blood volume index(ITBVI) and extravascular lung water index(EVLWI) of the PICCO group were elevated significantly after the treatment, the stroke volume(SV), CI and left ventricular end diastolic volume(LVEDV) of the bedside ultrasound group were elevated significantly after the treatment, while the inferior vena cava dilatation index(dIVC) was reduced significantly(P<0.05). The central venous pressure(CVP), mean arterial pressure(MAP) and central venous oxygen saturation(ScvO) of the two groups were elevated significantly after the treatment(P<0.05), and the lactic acid(Lac) level was reduced significantly(P<0.05). The Lac level of the PICCO group was significantly lower than that of the bedside ultrasound group after the treatment for 48 hours(P<0.05). The levels of cardiac function indexes NT-proBNP and cardiac troponin(cTnI) of the two groups were reduced after the treatment, and there were no significant differences between the two groups. There were no significant differences in the dosage of vasoactive drugs, number of infection cases, mechanical ventilation duration, treatment time in intensive care unit(ICU) and mortality within 30 days between the two groups. CONCLUSION Both PICCO and bedside ultrasound achieve good effect on guiding the fluid resuscitation for the patients with septic shock.
作者
邹红
陈柯宇
邹赟
王晓平
张春燕
王芳
ZOU Hong;CHEN Ke-yu;ZOU Yun;WANG Xiao-ping;ZHANG Chun-yan;WANG Fang(Kaizhou District People's Hospital,Chongqing 405400,China;不详)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2022年第5期698-702,共5页
Chinese Journal of Nosocomiology
基金
重庆市科技计划基金资助项目(cstc2015 shms-ztzx10011)。
