PiCCO及生物学指标对脓毒性休克患者的诊断及预后的影响研究

发布时间：2018-05-11 06:08

本文选题：PiCCO + 生物学指标　；参考：《延边大学》2017年硕士论文

【摘要】：目的:探讨脉搏指示剂连续心排出量监测(Pulse index Continuous Cardiac Output,PiCCO)对脓毒性休克患者的影响及早期血清生物学指标对脓毒性休克诊断及预后判断的影响。方法:选取2014年1月至2016年12月期间的延边大学附属医院重症医学科收治的脓毒性休克患者58例,选择其中重症监护病房(Intensive care unit,ICU)住院时间大于24小时的患者,根据是否行PiCCO监测指导治疗,分为对照组(24例)、PiCCO组(24例)。所有脓毒性休克患者(58例),根据其预后情况分为存活组(28例)、死亡组(30例)。收集对照组,PiCCO组患者一般资料、急性生理与慢性健康评分(Acute physiology and chronic health evaluation II,APCHEII评分)、血清学指标水平,两组患者的ICU住院时间、死亡率,中心静脉压(Central Venous Pressure,CVP),停用血管活性药百分率,治疗前3天总输液量。PiCCO组第1、2、3天的连续指标。收集存活组,死亡组患者年龄、入院时APCHEII评分、17项血清学指标。结果:1.对照组、PiCCO组患者年龄、性别,入院时SBP/DBP、APACHEII评分等无统计学意义(P0.05);2.治疗过程中,PiCCO监测指导治疗使血流动力学指标(CI、GEDI、ELWI、SVRI)维持在接近于正常值的范围内。治疗3天后,与对照组比较,PiCCO组患者72小时总输液量虽然无统计学意义,但是在数值上明显减少,且PiCCO组能更早的达到血流动力学稳态,72小时内有更高的血管活性药物停用率,具有统计学意义(P0.01);与对照组比较,经治疗后,PiCCO组患者具有更低APACHEII评分及更短的ICU住院时间,差异具有统计学意义(P0.05);两组患者死亡率比较无统计意义;治疗第3天,经比较两组患者的Lac、IL-6、NGAL、NT-proBNP、sCysc、PCT、sCRP等指标的水平差异具有统计学意义(P0.05或P0.01),PiCCO组患者具有更低的上述炎症介质和细胞因子水平。3.利用受试者工作特征曲线(Receive operating characteristic curve,ROC 曲线)回顾性分析CK-MB、NT-proBNP等17项细胞因子、炎症介质与脓毒性休克(58例)的关系,结果发现:IL-6、NGAL具有早期诊断脓毒性休克的预测价值,剩余指标中关系较大的依次是sCysc、CK-MB、UA。4.通过比较生存组与死亡组患者入院时APACHEII评分、Lac、sCysc等17项指标与预后的关系。结果显示APACHEII评分、Lac、sCysc、UA、NGAL、IL-6等6项指标与患者的预后密切相关,与对照组相比,存活组患者具有更低的APACHEII评分及Lac、sCysc、UA、NGAL、IL-6水平,差异具有统计学意义(P0.05或P0.01)。而两组患者的年龄、CK-MB、NT-proBNP、Myo、cTnI、PCT、WBC、sCRP、D-D、NEUT%、PLT、DBIL、sCr、TBIL、BUN等指标比较,差异均无统计学意义(这0.05)。分析58例脓毒性休克患者的基本资料及生物学指标,Logistic二元回归分析显示,APACHEII评分,IL-6、NGAL、Lac、sCysc、UA、NGAL是脓毒性休克死亡相关的因素(P值均0.05)。结论:1.PiCCO监测指导治疗有助于脓毒性休克患者早期达到血流动力学的稳态,减轻体内的炎症反应程度,具有更低的APACHE Ⅱ评分,最终缩短了脓毒性休克患者的ICU住院时间。2.IL-6、NGAL、sCysc、CK-MB、UA具有早期诊断脓毒性休克的预测价值,其中IL-6早期诊断预测价值更高,NGAL具有更高的敏感性和特异性。3.APACHEⅡ评分、血Lac、sCysc、UA、NGAL、IL-6水平与脓毒性休克患者预后相关,NGAL可能成为判断脓毒性休克预后的一个新的生物学标记物。
[Abstract]:Objective: To investigate the effect of Pulse index Continuous Cardiac Output (PiCCO) on septic shock and the effect of early serum biological indicators on the diagnosis and prognosis of septic shock. Methods: the collection of the Department of intensive medicine from January 2014 to December 2016, the Department of severe medicine, the Affiliated Hospital of Yanbian University. 58 patients with septic shock were treated with Intensive care unit (ICU), which were hospitalized for more than 24 hours. According to whether or not PiCCO monitoring was used, the patients were divided into control group (24 cases), PiCCO group (24 cases) and all septic shock patients (58 cases), and the prognosis was divided into survival group (28 cases) and death group (30 cases). The control group, the general data of the PiCCO group, the acute physiological and chronic health score (Acute physiology and chronic health evaluation II, APCHEII score), the level of serological index, the hospitalization time of the two groups of patients, the mortality, the central venous pressure (Central Venous), the percentage of vasoactive drugs, and the total of the 3 days before the treatment. The continuous indexes of.PiCCO group 1,2,3 days of the infusion volume were collected. The survival group, the age of the death group, the APCHEII score of the admission and the 17 serological indexes. Results: the 1. control group, the age, sex, SBP/DBP, APACHEII score in the group PiCCO were not statistically significant (P0.05); and during the 2. treatment, the PiCCO monitoring and guidance therapy made the hemodynamic index. (CI, GEDI, ELWI, SVRI) was maintained within the range of close to normal values. After 3 days of treatment, compared with the control group, the total infusion volume of the 72 hours in the PiCCO group was not statistically significant, but the value was significantly reduced, and the PiCCO group was able to reach hemodynamic homeostasis earlier, with a higher vasoactive drug discontinuation rate within 72 hours, with statistics. Significance (P0.01); compared with the control group, after treatment, the patients in group PiCCO had lower APACHEII score and shorter ICU hospitalization time, the difference was statistically significant (P0.05); the two groups of patients had no statistical significance; the levels of Lac, IL-6, NGAL, NT-proBNP, sCysc, PCT, sCRP, and other indicators were compared on the third day of treatment. Statistical significance (P0.05 or P0.01), group PiCCO patients had lower levels of the above inflammatory mediators and cytokine levels.3. using the subject work characteristic curve (Receive operating characteristic curve, ROC curve) retrospective analysis of CK-MB, NT-proBNP and other 17 cytokines, inflammatory mediators and septic shock (58 cases), the results found: IL -6, NGAL has the predictive value for the early diagnosis of septic shock. The remaining index of the remaining indexes is sCysc, CK-MB, and UA.4. through the comparison of the relationship between the APACHEII score, Lac, sCysc, and other 17 indexes of the survival group and the death group, Lac, sCysc and so on. The results show that the APACHEII score, Lac, sCysc, UA, sCysc and so on are the 6 indexes and the prognosis of the patients. Compared with the control group, the patients in the survival group had lower APACHEII scores and Lac, sCysc, UA, NGAL, IL-6 levels, and the differences were statistically significant (P0.05 or P0.01). The differences were not statistically significant (0.05) in the two groups of patients. The basic data and biological indexes of 58 patients with septic shock were analyzed. The Logistic two regression analysis showed that the APACHEII score, IL-6, NGAL, Lac, sCysc, UA, NGAL were the factors associated with the death of septic shock (P is 0.05). Conclusion: 1.PiCCO monitoring and guidance can help the patients with septic shock to reach the homeostasis of hemodynamic early and alleviate the early stage of the septic shock. The degree of inflammation in the body has a lower APACHE II score, which eventually shortens the ICU hospitalization time of septic shock patients.2.IL-6, NGAL, sCysc, CK-MB, and UA has a predictive value for early diagnosis of septic shock, of which the early diagnostic value of IL-6 is higher, NGAL has a higher sensitivity and specificity of.3.APACHE II score, Lac, sC. YSC, UA, NGAL and IL-6 levels are associated with the prognosis of septic shock. NGAL may be a new biomarker for predicting the prognosis of septic shock.

【学位授予单位】：延边大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R459.7

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