PICCO联合重症超声在脓毒性休克伴心功能不全患者中的应用
2021-10-26张秀丽郭亮林乐清
张秀丽 郭亮 林乐清
[摘要] 目的 研究脈波指示剂连续心排血量监测联合重症超声在脓毒性休克伴心功能不全患者中的应用。 方法 选取2016年1月至2020年6月收入杭州师范大学附属医院重症监护室的脓毒性休克伴心功能不全的40名患者，随机分为两组，观察组采用脉波指示剂连续心排血量监测联合重症超声（20例），对照组采用脉波指示剂连续心排血量监测（20例）。观察达到复苏目标液体总量、去甲肾上腺素剂量、血管外肺水、全心舒张末期容量、外周灌注指数、心率、CRRT使用率及28 d病死率。 结果 观察组复苏液体量（1.13±0.27）L及去甲肾上腺素剂量（4.28±1.20）μg/（kg·min），对照组复苏液体量（1.52±0.42） L及去甲肾上腺剂量（5.82±1.10）μg/（kg·min），较对照组低;观察组血管外肺水（4.70±0.85）mL/kg较对照组（5.32±0.72）mL/kg少，观察组全心舒张末期容量（636.92±61.34）mL/m2较对照组（735.09±56.05）mL/m2低、观察组PI（2.98±0.58）较对照组（2.44±0.39）增加，观察组（87.00±13.60）次/min心率较对照组（101.10±10.03）次/min下降，差异均有统计学意义（P<0.05）;观察组（10%）对照组（20%）相比，CRRT使用无差异（P>0.05），观察组28 d病死率（5%）和对照组（15%）比较无差异（P>0.05）。 结论 观察组可减少液体量及去甲肾上腺剂量，全心舒张末期容量低，肺水减少，组织灌注更佳，较少引起心动过速，不降低CRRT使用率及28 d病死率。
[关键词] 脉波指示剂连续心排血量监测;重症超声;脓毒性休克;心功能不全
[中图分类号] R459.7 [文献标识码] B [文章编号] 1673-9701（2021）24-0114-03
Application of PICCO combined with severe ultrasound in patients with septic shock and cardiac insufficiency
ZHANG Xiuli GUO Liang LIN Leqing
Intensive Care Unit， Affiliated Hospital of Hangzhou Normal University， Hangzhou 310015， China
[Abstract] Objective To study the application of pulse wave indicator continuous cardiac output monitoring combined with critical ultrasound in patients with septic shock and cardiac insufficiency. Methods A total of 40 patients with septic shock and cardiac insufficiency who were admitted to the Intensive Care Unit in the Affiliated Hospital of Hangzhou Normal University from January to February 2016 were randomly divided into two groups. The observation group used pulse wave indicator continuous cardiac output monitoring combined with critical ultrasound （20 cases）. The control group used the pulse wave indicator to monitor continuous cardiac output （20 cases）. The total fluid volume reaching the resuscitation target， norepinephrine dose， extravascular lung water， global end-diastolic volume， peripheral perfusion index， heart rate， CRRT usage rate， and 28-day case fatality rate were observed. Results The resuscitation fluid volume （1.13±0.27） L and norepinephrine dose （4.28±1.20） μg/（kg·min） in the observation group was lower than the resuscitation fluid volume （1.52±0.42） L and norepinephrine dose （5.82±1.10） μg/（kg·min） in the control group. The extravascular lung water （4.70±0.85） mL/kg in the observation group was less than （5.32±0.72） mL/kg in the control group. The observation group′s global end-diastolic volume （636.92±61.34） mL/m2 was lower than （735.09±56.05） mL/m2 of the control group. The PI of the observation group （2.98±0.58） was higher than （2.44±0.39） of the control group. The heart rate of the observation group （87.00±13.60） once/min was lower than that of the control group （101.10±10.03） once/min， and the difference was statistically significant （P>0.05）. There was no difference in the use of CRRT between the observation group （10%） and the control group （20%） （P>0.05）. There was no difference between the observation group （5%） and the control group （15%） in the 28 d case fatality rate（P>0.05）. Conclusion The observation group can reduce fluid volume and dose of norepinephrine， which has low end-diastolic volume， reduced lung water， better tissue perfusion and less tachycardia， and does not reduce CRRT usage and 28-day mortality.
