脉搏指示连续心排血量监测(PiCCO)在脓毒症休克合并心肌损害患者治疗中的临床价值

目的 观察脉搏指示连续心排血量监测（pulse indicator continuous cardiac output，PiCCO）对脓毒症休克合并心肌损害患者临床治疗的价值。方法 将37例脓毒症休克合并心肌损害患者随机分为常规对照组（C组）18例和PiCCO组（P组）19例。C组放置中心静脉导管，P组放置中心静脉导管和股动脉PiCCO导管，根据血流动力学监测指标指导患者的液体复苏、血管收缩药物（多巴胺）和正性肌力药物（多巴酚丁胺）的应用。记录两组患者复苏6h后相关参数（CVP、MAP、ScvO₂、尿量、血乳酸水平）、心功能指标（NT-proBNP，cTnI）的变化，同时记录两组患者6、24、48h的液体正平衡量、血管收缩药物（多巴胺）和正性肌力药物（多巴酚丁胺）的用量。结果 与常规对照组（C组）相比，P组治疗6h后ScvO₂升高、血乳酸水平降低，心功能指标cTnI降低，液体正平衡量增加（P均<0.05）；P组治疗6、24、48h多巴酚丁胺用量增加、多巴胺用量减少（P均<0.05）；治疗24、48h两组液体正平衡量相比，差异无统计学意义（P>0.05）；两组CVP、MAP、尿量相比，差异无统计学意义（P均>0.05）。结论 PiCCO监测可以指导脓毒症休克患者的液体复苏，在指导正性肌力药物应用的同时还可以减少血管收缩药物的应用、减轻心肌损害。

Clinical Value of the Pulse Indicator Continuous Cardiac Output Monitoring in Patients with Septic Shock and Myocardial Injury

Objective To explore the clinical value of the application of PiCCO system in the treatment of patients with septic shock and myocardial injury. Methods Thirty-seven patients with septic shock and myocardial injury were randomly divided into two groups:routing monitoring group (group C) and PiCCO monitoring group (group P), with 18 patients in group C and 19 patients in group P respectively. Patients in group C were given central venous catheterization to monitor hemodynamics, Patients in group P were given central venous catheterization and femoral artery catheterization with PiCCO catheters to monitor hemodynamics. Indexes based on hemodynamic monitoring were used to guide fluid resuscitation and application of vasoconstrictor (dopamine) and positive inotropic drug (dobutamine). Recovery relevant parameters such as central venous pressure (CVP), mean arterial pressure (MAP), central venous oxygen saturation (ScvO₂), urine volume, blood lactic acid and cardiac function parameters such as N-terminal B-type natriuretic peptide (NT-proBNP), cardiac troponin I (cTnI) were observed after treatment for 6 hours. In addition, positive fluid balance, dosages of vasoconstrictor drug(dopamine) and inotropic drug (dobutamine) were measured after treatment for 6, 24 and 48 hours. Results After treatment for 6 hours, PiCCO monitoring significantly increased ScvO₂ and positive fluid balance, but obviously decreased blood lactic acid level and cardiac function cTnI, as compared with group C (P<0.05). After treatment for6, 24 and 48 hours, PiCCO monitoring significantly increased the dosage of dobutamine, but obviously decreased the dosage of dopamine,as compared with group C (P<0.05). Treatment of 24 and 48 hours, there were no significant differences in positive fluid balance between the two groups (P>0.05). There were no significant differences in CVP, MAP and urine output between the two groups (P>0.05). Conclusion PiCCO monitoring can guide fluid resuscitation in patients with septic shock, meanwhile, it can also guide the application of inotropic drugs, decrease the dosage of vasoconstriction drugs, and reduce myocardial injury.