PICCO监测在创伤性急性呼吸窘迫综合征治疗中的应用研究

目的：探讨PICCO在指导创伤急性肺损伤（ALI）/急性呼吸窘迫综合症（ARDS）患者液体容量管理治疗及判断预后的意义,为创伤性ARDS治疗提供新的监测手段。方法：为前瞻性观察研究,对已诊断创伤性ARDS的患者进行随机分为实验组与对照组,两组患者均给予常规监护及一般治疗。实验组应用PiCCO对血流动力学的变化进行监测并进行早期积极的液体容量管理,对照组给予经验性液体治疗管理。采用统计学软件SPSS 17.0进行数据处理及分析。结果：与对照组比较PICCO组APPACHⅡ评分在24h和72h时明显降低（P〈0.05）;实验组肺泡-动脉氧分压差的变化72h后明显好于对照组（P〈0.01）;机械通气时间和入住EICU时间明显缩短（P〈0.01）。但对创伤性ARDS患者的死亡率并无明显影响（P〉0.05）。PICCO组中,EVLWI在存活组明显低于死亡组。结论：应用PICCO监测指导创伤性ARDS早期液体治疗,能有效缩短创伤性ARDS患者机械通气时间和入住EICU时间,EVLWI可有效评估创伤性ARDS患者预后。

Application research of PICCO system monitoring on the traumatic acute respiratory distress syndrome

Objective：To investigate whether pulse contour cardiac output（PiCCO）system monitoring will improve outcomes in critically ill patients with trauma-associated acute respiratory distress syndrome（ALI/ARDS） and to provide new monitoring measures.Method：To make one prospective observational study,patients who had been diagnosed as the trauma-associated ARDS were randomly divided into experimental and control groups.Both groups were treated with routine care and general treatment.Haemodynamics were assessed using the PiCCO system and the active management of early fluid resuscitation was made in the experimental group.The management of early fluid resuscitation according to the experience was made in the control group.SPSS software of version 17.0 was used to process and analysis data.Result：Compared with the control,APACHEⅡscore in PiCCO monitoring group decreased significantly both at 24 hand 72h（P0.05）.The differences of A-aDO2 between the control group and the PiCCO monitoring group were significant（P0.05） only at 72h but not at 24h.The length of staying in ICU and the time of mechanical ventilation reduced significantly（P0.01）compared with the control,but the difference between the mortality rate was not statistically significant（P0.05）.And there were also very significant differences in the extravascular lung water（EVLWI） between the death group and the survival group. Conclusion：Early fluid therapy in the management of critically ill patients with trauma-associated ARDS under the monitoring of the PICCO device can reduce the length of staying in ICU,and the time of mechanical ventilation could be reduced significantly.EVLWI can evaluate the prognosis effectively.