脉搏指示连续心排血量监测技术在神经重症患者抢救中的应用效果

目的 探讨脉搏指示连续心排血量(PICCO)技术在神经重症患者抢救中的应用效果.方法 选择皖南医学院附属黄山市人民医院2011年11月至2014年6月收住的神经重症患者30例,根据是否应用PICCO监测分为观察组(14例)和对照组(16例),观察组运用PICCO监测指导液体复苏及血管活性药物的应用,而对照组根据心率(HR)、血压、尿量、乳酸(LAC)及中心静脉压等指导治疗.比较两组患者治疗24 h后的平均动脉压(MAP)、HR、LAC清除率,比较两组患者28 d病死率及90 d恢复良好率,同时比较两组存活患者的机械通气时间及住ICU时间.结果 两组患者的年龄、性别、MAP、HR、LAC、疾病病种及危重程度(GCS、APACHE Ⅲ评分)等比较,差异无统计学意义(P>0.05);治疗24 h后,两组患者的HR差异无统计学意义(P>0.05),但观察组MAP及24 h LAC清除率高于对照组,差异有统计学意义(P<0.05);两组患者28 d病死率差异无统计学意义(P>0.05),但观察组90 d恢复良好率高于对照组,差异有统计学意义(P<0.05);两组存活患者机械通气时间及住ICU时间差异无统计学意义(P>0.05).结论 PICCO技术能提高神经重症早期的液体复苏效果,改善组织灌注,并改善预后,值得临床推广应用.

The application values of pulse induced contour cardiac output in rescue of neurological intensivepatients

Objective To discuss the application values of pulse induced contour cardiac output (PiCCO) in rescue of neurological intensivepatients.Methods With review of literature,30 patients with neurological intensive were selected in Department of Intensive Care Unit of Huangshan People''s Hospital form Nov 2011 to June 2014.According to under the PICCO monitor or not,all the subjects of study were divided into the observation group with 14 cases and the control group with 16 cases.In the observation group, PICCO monitor was used to guide fluid resuscitation,while heart rate (HR),blood pressure (BP),urine volume,lactic acid (LAC) and central venous pressure (CVP) were used in the control group.The mean arterial pressure (MAP),HR,elimination rate of blood lactic acid of the patients 24 h after treatment in two group were compared.28 days mortality,90 days good recovery rates (GCS>8),mechanical ventilation time and ICU stay time in survival were compared, too.Results The age,gender,MAP,HR,LAC,disease constitution and severity showed no significant difference between two groups before treatment (P>0.05).24 hafter treatment,there was no significant difference between two groups in HR (P>0.05).But the MAP and elimination rate of blood lactic acid of the observation group were significantly higher than those in the control group (P<0.05).There was no significant difference of 28 days mortality(P>0.05),however, 90 days good recovery rates were significantly higher (P<0.05).Meanwhile,there was no significant of mechanical ventilation time and ICU stay time in survival (P>0.05).Conclusion The pulse induced contour cardiac output (PiCCO) can improve resuscitation effect in early neurological intensivepatients, increase tissue perfusion, and improve prognosis,which is worth clinical application and promotion.