脉波指示连续心排量监测对脓毒症合并重度心功能不全患者预后的影响

目的研究脓毒症合并重度心功能不全患者的血流动力学、氧代谢特点,并比较脉波指示剂连续心排血量（pulse indicator continuous cardiac output,PiCCO）监测与传统监测指导早期目标导向性治疗预后的影响。方法选取25例伴有急性心功能衰竭的脓毒症患者,随机分为采用PiCCO监测组和常规监测组。比较两组患者平均ICU住院天数、血管活性药物用量、心功能改善时间、机械通气时间、乳酸清除率、液体平衡情况、28 d转归情况。结果 PiCCO监测组在疾病早期CI、dPmax显著低于正常,SRVI增高。PiCCO监测组患者入住ICU时间、平均机械通气时间及心功能好转时间较传统监测组明显缩短,且48 h内血管活性药物用量较传统监测组减少,总液体平衡情况两组间无显著差异,但PiCCO监测组液体负平衡出现时间较传统监测组提前（P〈0.01）。结论脓毒症合并重度心功能不全患者血流动力学早期呈现低排、高阻型的血流动力学特点,行PiCCO监测治疗可有效缩短患者入住ICU时间,平均机械通气时间,以及心功能好转时间。减少血管活性药物用量,提前出现液体负平衡。

Effect of monitoring with pulse indicator continuous cardiac output on the prognosis of sepsis patients with myocardial dysfunction

【Objective】To investigate the Hemodynamic and oxygen metabolism feature of sepsis patients with myocardial dysfunction,and compare the influence of pulse indicator continuous cardiac output（PiCCO） in monitoring outcome with conventional monitoring methods.【Methods】25 patients in ICU suffered from sepsis with myocardial dysfunction were enrolled,the patients were randomLy divided into PiCCO monitoring group and conventional monitoring group,then treated according to the early goal-directed therapy（EGDT）.The hemodynamic and oxygen metabolism were investigated,and compare the 28 day mortality rate,time of ICU stay,ventilation time,vasoactive drug dosage,Lactate clearance rate,and fluid balance.【Resluts】PiCCO monitoring group in the early hours,CI,dPmax below normal,SRVI higher than normal.The time of ICU stay,ventilation time,lactate clearance rate of PiCCO monitoring group were superior to those of the conventional group.There were no significant difference in total fluid balance of the two group,but the negative fluid balance appeared earlier in PiCCO monitoring group（P0.01）.【Conclusion】 Sepsis patients with myocardial dysfunction present low emission,high resistance hemodynamic characteristics in the early stage.Their time of ICU stay,ventilation time,vasoactive drug dosage,lactate clearance rate of PiCCO monitoring group were superior to those of the conventional group,as well as an earlier negative fluid balance.