脉搏指示连续心排血量监测技术在感染性休克合并急性呼吸窘迫综合征患者中的应用研究

发布时间：2018-09-01 13:41

【摘要】：目的探讨脉搏指示连续心排血量监测技术(PICCO)在感染性休克合并急性呼吸窘迫综合征(ARDS)患者中的应用效果。方法选取医院2011年1月-2015年12月收治的86例感染性休克合并ARDS患者。采用随机数字表法分为观察组和对照组,每组43例。对照组应用传统液体管理模式管理,观察组采用PICCO指导液体管理。对患者病原菌进行鉴定和药敏试验。监测液体复苏相关指标和疗效指标。结果 86例感染性休克合并ARDS患者共检出78株病原菌,其中革兰阴性菌64株占82.05%,革兰阳性菌11株占14.10%,真菌3株占3.85%。鲍曼不动杆菌和肺炎克雷伯菌对左氧氟沙星、阿米卡星、氯霉素和头孢哌酮/舒巴坦等耐药率较低。观察组液体复苏24h液体入量PaO_2/FiO_2均显著高于对照组(P0.05);观察组LAC水平,去甲肾上腺素和多巴胺用量均显著低于对照组(P0.05);观察组全心舒张末期容积指数(GEDVI)、胸腔内血容量指数(ITBVI)、全身血管阻力指数(SVRI)、心指数(CI)均显著高于对照组(P0.05);观察组血管外肺水指数(EVLWI),肺血管阻力指数(PVRI)均显著低于对照组(P0.05)。观察组心力衰竭和肺水肿发生率、28d病死率和机械通气时间均显著低于对照组(P0.05)。结论 PICCO指导感染性休克合并ARDS患者液体管理,有利于改善有效血容量、机体氧合状态,同时减少血管活性药物的应用,从而改善患者预后。
[Abstract]:Objective to investigate the effect of pulse indicator continuous cardiac output monitoring (PICCO) in patients with septic shock complicated with acute respiratory distress syndrome (ARDS). Methods 86 patients with septic shock complicated with ARDS were selected from January 2011 to December 2015. The patients were randomly divided into observation group (n = 43) and control group (n = 43). The control group was managed by traditional liquid management mode, and the observation group was guided by PICCO. The pathogenic bacteria of patients were identified and drug sensitive test was carried out. Monitor the indexes of fluid resuscitation and curative effect. Results A total of 78 strains of pathogenic bacteria were detected in 86 patients with septic shock and ARDS, of which 64 were Gram-negative bacteria (82.05), 11 Gram-positive bacteria (14.10m) and 3 fungi (3.85g). Acinetobacter baumannii and Klebsiella pneumoniae showed low resistance to levofloxacin, amikacin, chloramphenicol and cefoperazone / sulbactam. The PaO_2/FiO_2 of 24 h fluid resuscitation in the observation group was significantly higher than that in the control group (P0.05), the level of LAC in the observation group was significantly higher than that in the control group. The dosage of norepinephrine and dopamine was significantly lower than that of the control group (P0.05), and the total cardiac end-diastolic volume index (GEDVI), intrathoracic blood volume index (ITBVI), systemic vascular resistance index (SVRI), cardiac index (SVRI),) (CI) were significantly higher in the observation group than those in the control group (P0.05). The pulmonary water index (EVLWI),) and pulmonary vascular resistance index (PVRI) were significantly lower than those in the control group (P0.05). The incidence of heart failure and pulmonary edema in the observation group was significantly lower than that in the control group (P0.05). Conclusion PICCO guidance of fluid management in patients with septic shock combined with ARDS is beneficial to improve the effective blood volume, oxygenation, and reduce the use of vasoactive drugs, thus improving the prognosis of the patients.
【作者单位】：河北医科大学第三医院重症医学科;
【分类号】：R459.7;R563.8

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