PICCO容量监测在脓毒性休克合并急性呼吸窘迫综合征患者液体复苏中的临床应用

目的 探讨脉搏指示连续心排出量监测技术（pulse-Indicated continuous cardiac output，PICCO）对重症监护病房脓毒性休克合并急性呼吸窘迫综合征（acute respiratory distress syndrom，ARDS）患者早期液体复苏的指导意义。方法 选取2016年3月~2017年3月在笔者医院重症医学科进行治疗的60例脓毒性休克合并ARDS的患者作为研究对象，将患者采用数字表法随机分为对照组30例和研究组30例，在抗感染、营养支持、呼吸支持治疗的基础上，对照组患者以中心静脉压（CVP）作为指导液体复苏指标，研究组以PICCO监测指标指导患者进行液体复苏，比较两种方法下患者的复苏效果及转归。结果 复苏后6h，对照组与研究组液体入量、血乳酸值、尿量、氧合指数（PaO₂/FiO₂）比较，差异有统计学意义（P<0.05）；复苏后24h，对照组与研究组液体入量、血乳酸值、尿量、ScvO₂、PaO₂/FiO₂比较，差异有统计学意义（P<0.05）；两组患者6h早期目标导向治疗（early goal directed therapy，EGDT）达标率、血管活性药物使用时间、机械通气时间、住ICU时间、28天病死率比较，差异有统计学意义（P<0.05）。结论 PICCO监测可明显改善脓毒性休克合并ARDS患者的液体复苏的复苏效果及转归，值得临床推广应用。

Application of Pulse-Indicated Continuous Cardiac Output in Patient with Septic Shock and Acute Respiratory Distress Syndrome

Objective To investigate the application of pulse-indicated continuous cardiac output(PICCO) in patients with septic shock and ARDS in intensive care unit. Methods A total of 60 patents with septic shock and ARDS were selected in ICU from Mar 2016 to Mar 2017. The patients were divided into PICCO group and control group. The way of anti-infection, nutrition support, breath supportting were same. Resuscitation effect and outcome were compared between the two groups. Results There were statistically significant differences in fluid intake, blood lactic acid, urine volume,PaO₂/FiO₂ between PICCO group and control group after six hours'' fluid resuscitation (P<0.05). There were statistically significant differences in fluid intake, blood lactic acid, urine volume, ScvO₂, PaO₂/FiO₂ between PICCO group and control group after twenty-four hours'' fluid resuscitation (P<0.05). There were statistically significant differences of six hours'' early goal directed therapy rate, the use time of vasoactive agent, mechanical ventilation time, the duration of ICU stay, 28 days'' mortality between PICCO group and control group (P<0.05). Conclusion Fluid management therapy for the treatment of septic shock complicated with ARDS under the monitoring of PICCO can improve resuscitation effect and outcome,so it''s worth clinical application.