基于早期目标导向液体治疗的PICCO监测在严重多发伤病人容量管理中的应用

周丙梅; 王银娥; 徐亚运; 周英; 王振杰

doi:10.13898/j.cnki.issn.1000-2200.2021.10.037

基于早期目标导向液体治疗的PICCO监测在严重多发伤病人容量管理中的应用

Clinical application value of PICCO monitoring based on early goal-directed fluid therapy in volume management of patients with severe multiple injuries

摘要

摘要:
目的探讨基于早期目标导向液体治疗（EGDT）的脉搏指示连续心排出量监测（PICCO）技术在严重多发伤病人容量管理中的临床应用。
方法选取严重多发伤病人60例，采用随机数字法分为对照组和观察组，各30例。对照组在中心静脉压（CVP）监测下行容量管理，观察组在PICCO监测下行容量管理。比较2组病人治疗前后危重程度评分、各项生理指标变化和预后情况，并比较观察组治疗前后血液动力学参数变化。
结果观察组治疗后6、24、48 h的APACHEⅡ评分和治疗后24、48 h的ISS评分均明显低于对照组（P＜0.01）。观察组治疗后6、24、48 h心率、平均动脉压、血清乳酸水平、尿量和PaO₂/FiO₂与对照组差异均有统计学意义（P＜0.05~P＜0.01）。观察组病人机械通气时间、置监护室时间、72 h液体复苏总量均明显少于对照组（P＜0.01），6 h液体复苏达标率高于对照组（P＜0.05），2组28 d病死率差异无统计学意义（P>0.05）。观察组组内比较显示，治疗后6、24、48 h，病人心排血指数、胸腔内血容量指数、全心舒张末期容积指数和外周血管阻力指数均较治疗前升高（P＜0.05~P＜0.01），血管外肺水指数均较治疗前明显降低（P＜0.05~P＜0.01）。
结论基于早期目标导向液体治疗的PICCO监测应用于严重多发伤病人容量管理，能改善病人病情危重程度和各项生理指标及血液动力学状态，对提高临床治疗效果和改善预后有一定作用。

Abstract:
ObjectiveTo discuss the clinical application value of pulse indicator continuous cardiac output(PICCO) monitoring based on guidance of early goal-directed fluid therapy(EGDT) in patients with severe multiple injuries.
MethodsSixty patients with severe multiple injuries were divided into the control group and observation group by random number table method(30 cases in each group).The control group was given the capacity management under central venous pressure(CVP) monitoring, and the observation group was given the capacity management under PICCO.The critical degree score, changes of various physiological indexes and prognosis were compared between two groups, and the hemodynamic parameters changes were compared in the observation group between before and after treatment.
ResultsThe APACHE Ⅱ scores after 6, 24 and 48 h of treatment and ISS scores after 24 and 48 h of treatment in observation group were significantly lower than those in control group(P < 0.01).The differences of the heart rate, mean arterial pressure, serum lactic acid level, urine volume and PaO₂/FiO₂ after 6, 24 and 48 h of treatment between two groups were statistically significant(P < 0.05 to P < 0.01).The mechanical ventilation time, duration of ICU and 72 h total fluid resuscitation in observation group were significantly less than those in control group(P < 0.01), and the standard rate of 6 h fluid resuscitation in observation group was significantly higher than that in control group(P < 0.05), and there was no statistical significance in the 28 d mortality between two groups(P>0.05).The results of comparison within the observation group showed that the cardiac output index, intrathoracic blood volume index, total end-diastolic volume index and peripheral vascular resistance index increased after 6, 24 and 48 h of treatment increased(P < 0.05 to P < 0.01), and the extracascular pulmonary fluid index decreased significantly compared with before treatment(P < 0.05 to P < 0.01).
ConclusionsThe PICCO monitoring based on EGDT can be used in volume management of patients with severe multiple injuries, which can improve the severity, physiological indicators and hemodynamic status of patients, and has a certain effect on improving clinical treatment effect and prognosis.

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