脉搏指数连续心排血量监测在脓毒性休克早期液体复苏中的应用

目的：评价脉搏指数连续心排血量监测（PICCO）在脓毒性休克早期液体复苏中的应用价值。方法将40例符合脓毒性休克入选标准的病例随机分为PICCO组和对照组，每组各20例，在抗感染等基本治疗基础上， PICCO组患者于PICCO监测容量指标指导下进行治疗，对照组患者参照中心静脉压指导进行常规治疗。通过对比分析两组患者复苏治疗6 h、24 h 后，血乳酸值＜2 mmoL/L 和中心静脉氧饱和度≥70％的病例数，以及24 h复苏液体量、去甲肾上腺素用量、肺水肿发生率、机械通气时间、入住ICU天数、28 d病死率等指标评价PICCO的应用价值。结果经过液体复苏6 h后，两组的血乳酸＜2 mmoL/L 和中心静脉氧饱和度≥70％的例数比较，差异均无统计学意义（χ2分别=0.11、0.11，P均＞0.05），而经复苏24 h后两组的发生例数比较，差异均有统计学意义（χ2分别=2.75、2.98，P均＜0.05）。与对照组比较，PICCO组24 h复苏的液体量、去甲肾上腺素用量及肺水肿比率明显降低，差异均有统计学意义（t分别=-2.33、-2.27，χ2=5.16，P均＜0.05），而两组的机械通气治疗时间、住ICU天数和28 d病死率比较，差异均无统计学意义（t分别=-1.97、-1.72，χ2=0.00，P均＞0.05）。结论 PICCO监测可以准确、可靠地评估患者容量状态，指导对脓毒性休克患者早期液体复苏治疗及血管活性药物应用，但不能明显改善脓毒性休克患者的机械通气时间、入住ICU天数、28 d病死率等方面指标。

Value of pulse-indicated continuous cardiac output monitoring in early fluid resuscitation of septic shock

Objective To evaluate pulse indicator continuous cardiac output monitoring （PICCO） application value in early fluid resuscitation of septic shock. Methods Forty patients with septic shock were randomly divided into treatment group （n=20） and control group （n=20）. Based on the anti-infection and other basic therapy, the treatment group was treated according to the index of PICCO monitoring while the control group was treated according to the central venous pressure. The patients whose lactic acid level〈2 mmol/L and central venous oxygen saturation≥70%were recorded at 6 hours, 24 hours and volume of fluid resuscitation in 24 hours, norepinephrine dosage, the rate of pulmonary edema, mechanical ventilation time, ICU days, and 28 days mortality were measured. Results After fluid resuscitation for 6 hours, the dif-ferences of patients whose lactic acid level〈2 mmol/L and central venous oxygen saturation ≥70% between two group were not statistically significant （χ2=0.11,0.11, P〉0.05）while it was statistically significant between two groups after the recovery 24 hours （χ2=2.75, 2.98,P〈0.05）. Compared with the control group, the volume of fluid resuscitation in 24 hours, norepinephrine dosage and the rate of pulmonary edema in PICCO group were significantly reduced （t=-2.33,-2.27,χ2=5.16, P〈0.05）. But the mechanical ventilation time, ICU days and the 28 days mortality between two group had no significant difference（t=-1.97, -1.72,χ2=0.00, P〉0.05）. Conclusion PICCO monitoring is accurate and reliable to as-sess patients＇capacity status and guide the septic shock patients of the treatment with early fluid resuscitation and applica-tion of vasoactive drugs, and avoid pulmonary edema which caused by blind fluid infusion. But it can not significantly im-prove the duration of mechanical ventilation, ICU stay days, 28 days mortality and other indicators.