PiCCO监测下的液体管理对老年急性呼吸窘迫综合征患者预后的意义
发布时间：2018-10-05 18:04
【摘要】：目的探讨脉波轮廓温度稀释连续心排量监测技术(Pi CCO)血流动力学监测对急性呼吸窘迫综合征(ARDS)患者液体管理的意义。方法因ARDS收入院、治疗时间超过1 w的患者46例,入院后随机分为常规液体管理组及Pi CCO液体管理组。入院后所有患者首先经验性应用抗生素,并根据痰培养及血培养等病原学检查调整抗生素应用。根据患者氧合、动脉血气进行无创或有创呼吸机辅助通气治疗。常规液体管理组监测患者血压、心率、中心静脉压(CVP)等,依据心率、血压、CVP等指标进行液体管理。Pi CCO液体管理每日进行2次Pi CCO监测,根据Pi CCO数据进行液体管理。检测血浆白细胞介素(IL)-1,IL-10,肿瘤坏死因子(TNF)-α等炎症因子水平,计算每位患者序贯器官衰竭估计(SOFA)评分、机械通气时间、重症监护室(ICU)住院时间等,3个月统计患者病死率。结果 Pi CCO液体管理组患者累计液体入量较常规液体管理组明显减少,炎症因子水平降低,病死率降低(均P0.05)。结论 Pi CCO血流动力学监测可以减少ARDS患者的液体正平衡,减轻炎症反应,降低病死率。
[Abstract]:Objective to investigate the significance of (Pi CCO) hemodynamic monitoring in the management of fluid in patients with acute respiratory distress syndrome (ARDS) by pulse temperature dilution continuous cardiac output monitoring. Methods 46 patients with ARDS admitted to hospital for more than 1 week were randomly divided into routine fluid management group and Pi CCO fluid management group. After admission, all patients were treated with antibiotics empirically, and the antibiotics were adjusted according to sputum culture and blood culture. Non-invasive or invasive ventilator-assisted ventilation was performed according to oxygenation and arterial blood gas. The blood pressure, heart rate and central venous pressure (CVP) were monitored in the routine fluid management group. According to the indexes of heart rate and blood pressure, Pi CCO was monitored twice a day by the liquid management of Pi CCO, and the liquid was managed according to the Pi CCO data. The levels of IL-10, (TNF)-伪 and IL-10 in plasma were measured. The (SOFA) score, the time of mechanical ventilation, the hospitalization time of (ICU) in intensive care unit were calculated for each patient. The mortality rate was calculated at 3 months. Results the accumulative fluid volume in Pi CCO liquid management group was significantly lower than that in the conventional liquid management group, the level of inflammatory factors and the mortality were decreased (P0.05). Conclusion Pi CCO hemodynamic monitoring can reduce the positive liquid balance, reduce inflammatory reaction and reduce mortality in patients with ARDS.
【作者单位】： 深圳市人民医院急诊科;
【基金】：深圳市科技计划项目(20140416122812041)
【分类号】：R563.8
[Abstract]:Objective to investigate the significance of (Pi CCO) hemodynamic monitoring in the management of fluid in patients with acute respiratory distress syndrome (ARDS) by pulse temperature dilution continuous cardiac output monitoring. Methods 46 patients with ARDS admitted to hospital for more than 1 week were randomly divided into routine fluid management group and Pi CCO fluid management group. After admission, all patients were treated with antibiotics empirically, and the antibiotics were adjusted according to sputum culture and blood culture. Non-invasive or invasive ventilator-assisted ventilation was performed according to oxygenation and arterial blood gas. The blood pressure, heart rate and central venous pressure (CVP) were monitored in the routine fluid management group. According to the indexes of heart rate and blood pressure, Pi CCO was monitored twice a day by the liquid management of Pi CCO, and the liquid was managed according to the Pi CCO data. The levels of IL-10, (TNF)-伪 and IL-10 in plasma were measured. The (SOFA) score, the time of mechanical ventilation, the hospitalization time of (ICU) in intensive care unit were calculated for each patient. The mortality rate was calculated at 3 months. Results the accumulative fluid volume in Pi CCO liquid management group was significantly lower than that in the conventional liquid management group, the level of inflammatory factors and the mortality were decreased (P0.05). Conclusion Pi CCO hemodynamic monitoring can reduce the positive liquid balance, reduce inflammatory reaction and reduce mortality in patients with ARDS.
【作者单位】： 深圳市人民医院急诊科;
【基金】：深圳市科技计划项目(20140416122812041)
【分类号】：R563.8
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