PICCO监测下脓毒症休克患者复苏实施时间与预后的关系

目的 观察并评估脓毒症休克患者在脉搏指示连续心排血量(PICCO)监测指导下实施液体复苏的不同达标时间对预后的影响。方法 采用回顾性研究的方法,根据PICCO监测的指标即胸腔内血容量指数达到850~1 000 mL/m²时间的不同分为0~6 h达标组和6~12 h达标组。记录两组患者入院后6 h、12 h、24 h和48 h的血气分析、乳酸、感染相关的器官衰竭评分(即SOFA评分)、ICU住院天数、带机时间等,并记录7天、28天病死率。结果 治疗24 h后0~6 h达标组乳酸及SOFA评分明显低于6~12 h达标组,并且28天病死率明显降低。0~6 h达标组患者较6~12 h达标组的带机时间缩短、ICU住院天数减少,7天病死率有所减少,但差异无统计学意义。两组患者治疗后的氧合指数、乳酸等指标均较入院时好转。结论 在PICCO监测指导下对脓毒症休克患者实施液体复苏治疗,6 h达标较12 h达标可明显降低SOFA评分及28天病死率。6 h与12 h使ITBVI达到850~1 000 mL/m²均可改善患者预后。

Relationship between fluid resuscitation under PICCO in different time and the prognosis of patients with septic shock

Objective To observe and evaluate the effect of different fluid resuscitationstandard time on the prognosis of patients with septic shock under the guidance of PICCO monitoring. Methods A retrospective study was used. The patients divided into 0~6 h standard group and 6~12 h standard group according to the different time when ITBVI reached 850~1 000mL/m² monitored by PICCO. Blood gas analysis, lactic acid, SOFA scorewere recorded at 6 h, 12 h, 24 h and 48 h after admission, length of stay in ICU, mechanical ventilation time, and the fatality rate at 7 and 28 days were recorded. Results After 24 h of treatment, lactic acid and SOFA scores in the 0~6 h group were significantly lower than those in the 6~12 h group, and the fatality rate was significantly reduced at 28 days. Compared with the 6~12 h standard group, patients in the 0~6 h standard group had shorter mechanical ventilation time, shorter time in ICU, and less 7-day mortality, but the difference was not statistically significant. After treatment, the indexes of oxygenation index and lactic acid in both groups were better than those at 0 h. Conclusion Fluid resuscitation therapy for patients with septic shock under the guidance of PICCO monitoring can significantly reduce SOFA score and 28-day mortality after reaching the standard at 6 h compared with 12h. Both 6 h and 12 h ITBVI reaching 850~1 000 mL/m² can improve the prognosis of patients.