贵州医科大学学报

2017, v.42;No.200(05) 583-587

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脉搏指示连续心输出量监测在重症患者血液净化中的应用价值
Clinical value of PICCO Monitoring in Blood Purification for Critically Ill Patients

杨恩宇;唐忠平;王河焱;王迪芬;
YANG Enyu;TANG Zhongping;WANG Heyan;WANG Difen;Guizhou Medical University;ICU,the First People's Hospital of Guiyang;ICU,the Affiliated Hospital of Guizhou Medical University;

摘要(Abstract):

目的:探讨脉搏指示连续心输出量(PICCO)监测对指导重症患者血液净化的应用价值。方法:选择行持续血液净化(CBP)治疗的重症患者36例,随机均分为观察组和对照组,在CBP治疗期间,对照组使用基础监护联合中心静脉压(CVP)监测,观察组在对照组基础增加PICCO监测;比较CBP治疗前(0 h),治疗后24及72 h时两组患者急性生理学与慢性健康状况II(APACHEII)评分、氧合指数(PaO_2/FiO_2),治疗后24、72 h时的低血压发生率,在0~24 h、0~72 h时段液体平衡量及去甲肾上腺素用量;比较CBP治疗前(0 h),治疗后24、48 h及72 h时观察组患者胸腔内血容量指数(ITBI)、全心舒张末期容积指数(GEDVI)、心指数(CI)、每搏变异率(SVV)、调整脱水量及CVP的变化情况。结果:CBP治疗前两组患者的APACHEII评分、PaO_2/FiO_2比较,差异无统计学意义(P>0.05);CBP治疗后,观察组患者去甲肾上腺素用量和低血压发生率明显低于对照组,APACHEII评分明显低于对照组,PaO_2/FiO_2明显高于对照组(P<0.05),0~24 h、0~72 h的液体负平衡量明显多于对照组(P<0.05);在观察组中,CVP在治疗前(0 h)、治疗后24、48及72 h之间无明显变化(P>0.05),ITBI、GEDVI、CI、SVV在治疗前(0 h)、治疗后24、48及72h之间存在显著的波动(P<0.05)。结论:PICCO监测可用于指导重症患者CBP期间的容量管理,效果优于单一CVP监测。
Objective: To investigate the applied value of pulse indicate contour cardiac output(PICCO) monitoring in guiding blood purification for critically ill patients. Methods: Thirty-six critically ill patients who underwent continuous blood purification(CBP) were enrolled in this study. They were randomly divided into observation group and control group. In the process of CBP,the control group received basic monitoring plus central venous pressure(CVP) monitoring,while the observation group received basic monitoring plus central venous pressure(CVP) combined with PICCO. The acute physiology and chronic health evaluation(APACHE) II score,oxygenation index(PaO_2/FiO_2),incidence of hypotension and liquid balance volume and norepinephrine dosage were compared between before CBP treatment(0 h),24 and 72 h after CBP treatment. The intrathoracic blood index(ITBI),global end diastolic volume index(GEDVI),cardiac index(CI),stroke volume variation(SVV),adjusteddehydration volume and central venous pressure(CVP) in observation group were compared between before CBP treatment(0 h),24,48 and 72 h after CBP treatment. Results: There was no statistically differences in APACHE II score and PaO_2/FiO 2between observation group and control group before and after CPB treatment(P > 0. 05). After CPB treatment,norepinephrine dosage,incidence of hypotension and APACHE II score in observation were significantly lower that their counterparts in control group while PaO_2/FiO 2in observation group was significantly higher than that of control group(P < 0.05). The liquid negative balance volume in observation group was significantly larger than that of control group during the period of 0 ~ 24 h and 0 ~ 72 h after CBP treatment(P < 0. 05). In observation group,there was no statistically significant difference in CVP between before treatment,24 h after treatment,48 h after treatment and 72 h after treatment(P > 0. 05). There were significant fluctuations in ITBI,GEDVI,CI,SVV between before treatment,24 h after treatment,48 h after treatment and 72 h after treatment(P < 0. 05). Conclusion: PICCO monitoring is suitable for guiding the fluid management of CBP in critically ill patients,whose effect is better than single CVP monitoring.

关键词(KeyWords): 净化,血液;危重病;脉搏指示连续心输出量监测;中心静脉压
purification,blood;critically ill;pulse indicate contour cardiac output monitoring;central venous pressure

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作者(Author): 杨恩宇;唐忠平;王河焱;王迪芬;
YANG Enyu;TANG Zhongping;WANG Heyan;WANG Difen;Guizhou Medical University;ICU,the First People's Hospital of Guiyang;ICU,the Affiliated Hospital of Guizhou Medical University;

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DOI: 10.19367/j.cnki.1000-2707.2017.05.020

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