PICCO和CVP监测在脓毒性休克并发心功能不全患者治疗中的应用价值

目的：探讨脉搏指示连续心排血量（PICCO）和中心静脉压（CVP）监测下脓毒性休克并发心功能不全患者的治疗效果，阐明PICCO和CVP监测的临床意义。方法：137例脓毒性休克并发心功能不全患者随机分为CVP组（68例）和PICCO组（69例）。CVP组进行CVP监测指导治疗，PICCO组进行PICCO监测指导治疗。分别检测2组患者治疗前及治疗6、24和48 h后乳酸及B型脑钠肽（BNP）水平、中心静脉血氧饱和度（ScvO₂）、心率（HR）、平均动脉压（MAP）和CVP，记录PICCO组患者血流动力学参数，分别记录2组患者血管活性药物使用时间、ICU住院时间、多器官功能障碍综合征（MODS）发生率、机械通气时间和28 d死亡率。结果：与CVP组比较，PICCO组患者治疗6、24和48 h后乳酸和BNP水平及HR均明显降低（P<0.05），乳酸清除率、ScvO₂、MAP和CVP均明显升高（P<0.05）；PICCO组MAP水平明显高于同时间点CVP组（P<0.05），ScvO₂在治疗48 h后明显高于同时间点CVP组（P<0.05），而2组患者CVP水平同时间点比较差异无统计学意义（P>0.05）；2组患者MODS发生率和28 d死亡率比较差异均无统计学意义（P>0.05），但PICCO组患者血管活性药物使用时间、ICU住院时间和机械通气时间均明显短于CVP组（P<0.05）。结论：PICCO监测指导治疗脓毒性休克并发心功能不全优于CVP的监测，具有积极的临床意义。

Application value of PICCO and CVP monitoring in treatment of patients with septic shock complicated with cardiac insufficiency

Objective:To investigate the efficacies of pulsed continuous cardiac output (PICCO) and central venous pressure (CVP) monitoring in the treatment of the patients with sepsis shock complicated with cardiac insufficiency, and to clarify the clinical significance of PICCO and CVP monitoring. Methods:A total of 137 cases of septic shock combined with cardiac insufficiency patients were randomly divided into CVP group (n=68) and PICCO group (n=69). The patients in CVP group were treated with CVP monitoring to guide therapy, and the patients in PICCO group were treated with PICCO monitoring to guide therapy.The levels of lactic acid and B brain natriuretic peptide (BNP), central venous oxygen saturation (ScvO₂), heart rate (HR), mean arterial pressure (MAP) and CVP of the patients in two groups were detected before treatment and 6, 24, 48 h after treatment, respectively; the hemodynamic parameters of the patients of PICCO group were recorded; the vasoactive drug use time,the ICU hospitalization time, the incidence rates of multiple organ dysfunction syndrome (MODS), the mechanical ventilation time and the 28 d-mortality rates of the patients were recorded. Results:Compared with CVP group, the levels lactic acid and BNP and HR of the patients in PICCO group at 6, 24, and 48 h after treatment were significantly decreased (P<0.05), and the scavenging rates of lactic acid were significantly increased(P<0.05); the levels of ScvO₂, MAP and CVP were significantly increased (P<0.05). The levels of MAP of the patients in PICCO group were significantly higher than those in CVP group at the same time(P<0.05), after 48 h of treatment, the ScvO₂ levels in PICCO group were significantly higher than those in CVP group at the same time(P<0.05), but there was no significant difference in the CVP levels of the patients between two groups at the same time (P>0.05). There were no significant differences in the incidence rates of MODS and 28 d-mortality rates between two groups(P>0.05); however the use time of vasoactive drugs, the ICU hospitalization time and the mechanical ventilation time of the patients in PICCO group were significantly shorter than those in CVP group (P<0.05). Conclusion:PICCO monitoring guides the treatment of septic shock complicated with cardiac insufficiency better than CVP monitoring, and has positive clinical significance.