脉搏指示连续心排出量技术在重症肺炎患者液体管理中的作用

目的分析脉搏指示连续心排出量（PiCCO）技术对ICU内重症肺炎患者液体管理的指导意义。方法回顾性分析我院ICU内2010年11月至2011年8月期间采用PiCCO技术的15例重症肺炎患者（PiCCO组）的临床资料，选择同期仅CVP监测的重症肺炎患者15例为CVP组。分别记录各组的临床肺部感染评分（cps），记录监测第24、48、72小时的全心舒张末期容积（GEDV）、胸腔内血容量（ITBV）、脉压变异率（PPV）、血管外肺水（EVLW）及中心静脉压（CVP）；进行GEDV、IrrBV与CVP及EVLW与氧合指数之间的相关性分析。结果PiCCO组第48、72小时氧合指数明显高于CVP组[分别为（157±43）比（83±39），（216±40）比（163±37）]，血乳酸及CPIS明显低于CVP组[血乳酸：分别为（2．4±0．6）mmol／L比（3．0±1．1）mmol／L，（1．1±0．5）mmol／L比（2．5±0．8）mmol／L；CPIS：分别为（5．3±1．7）分比（6．4±2．1）分，（3．1±1．5）分比（5．3±1.6）分]，差异均有统计学意义（均P〈0．05）。PiCCO组第48、72小时总入量及液体出入平衡量明显少于CVP组[总入量：分别为（2836±291）ml比（3351±510）ml，（2510±203）ITll比（29814-301）ml；液体平衡量：分别为（251±147）ml比（764±211）ml，（217±212）ml比（443±176）m1]，差异均有统计学意义（均P〈0．05）。PiCCO组的呼吸机使用时间和ICU住院时问均明显少于CVP组[分别为（11±4）d比（18±5）d，（13±5）d比（19±5）d]，差异均有统计学意义（均P〈0．05）；2组患者住院费用比较差异无统计学意义（P〉0．05）。GEDV与CVP及11rBV与CVP相关系数分别为-0．134、-0．145，相关性较弱（P〉0．05）。第48、72小时的EVLw与相应点氧合指数相关系数分别为-0．414、-0．465，相关性强（P〈0．05）。结论PiCCO技术有助于了解重症肺炎患者液体复苏情况，能明显降低总人液量，明显改善患者氧合指数，减少呼吸机时间，缩短ICU住院时间，不增加患者治疗费用。

Guiding significance of pulse-induced continuous cardiac output technology for fluid management of patients with severe pneumonia

Objective To analyze the guiding significance of the pulse indicate continuous cardiac output （PiCCO） technology for fluid management of patients with severe pneumonia in ICU. Methods From November 2010 to August 2011 in ICU in our hospital, 15 cases of severe pneumonia treated with PiCCO were included（ PiCCO group）, and another 15 cases treated with CVP monitoring alone during the same period were included in CVP group. Separately clinical pulmonary infection score （the CPIS） was recorded and end-diastolic volume （GEDV）, intrathoracic blood volume （ITBV）, pulse pressure variation rate （PPV）, extravascular lung water （EVLW） and central venous pressure （CVP） at 24, 48 and 72 hours were recorded. The relationship of GEDV, ITBV, CVP, EVLW and the oxygenation index was calculated. Results In the PiCCO group, oxygenation index of 48 hours and 72 hours was significantly higher than that in CVP group [ （157 ± 43 ）vs （83 ± 39）, （216 ± 40）vs（ 163 ±37 ） ], and blood lactate and CPIS were lower than thaose in CVP group [ blood lactate： （ 2.4 ± 0.6 ） mmol/L vs （ 3.0 ± 1.1）mmol/L （1.1±0.5）mmol/L vs （2.5±0.8）mmol/L; CPIS： （5.3±1.7）scores vs （6.4±2. 1）scores, （ 3. 1 ± 1.5 ） scores vs （ 5.3 ± 1.6 ） scores ], and the differences were statistically significant （ P 〈 0.05 ）. The total intake and fluid balance amount of the PiCCO group was significantly less than those in CVP group in 48 hours, 72 hours [total intake： （2836 ±291）ml vs （3351 ±510）ml, （2510 ±203）ml vs （2981 ±301）ml; amount of fluid balance： （251 ± 147） ml vs （764 ±211 ）ml, （217±212）ml vs （443 ± 176）ml respectively, all P 〈0.05]. Venti- lator time and length of ICU of the PiCCO group were significantly less than those in CVP group [ （11 ±4）d vs （18±5）d, （13±5）d vs （19 ±5）d, respectively, P〈0.05] ; Hospitalization costs of two groups was not statistically significant （P 〉 0.05 ）. The correlation coefficients of GEDV with CVP and ITBV with CVP were -0. 134, - 0. 145, the correlation was weak （ P 〉 0.05 ）. At 48 hours and 72 hours, the correlation coefficients of EVLW and the oxygenation index were -0.414, -0. 465, and the correlation was strong（ P 〈 0.05 ）. Corldusions It ishelpful to know the fluid resuscitation of severe pneumonia with PICCO. PiCCO can reduce the total fluid volume, improve oxygenation index, reduce the time of ventilator and shorten the length of ICU stay.