PICCO监测指导重症患者血液净化的应用价值

发布时间：2018-04-14 00:38

  本文选题：PICCO + 危重患者　； 参考：《贵州医科大学》2017年硕士论文

【摘要】：目的:探讨脉搏指示连续心输出量(pulse indicate contour cardiac output,PICCO)监测对指导重症患者血液净化的应用价值。方法:采用前瞻性临床研究方法,研究对象为2015年4月至2016年9月期间,贵阳市第一人民医院重症医学科收治的行连续性血液净化(continuous blood purification,CBP)治疗的患者,共为36例,将研究对象随机分为2组,18例患者行中心静脉、股动脉穿刺后连接PICCO容量监测仪监测胸腔内血容量指数(intrathoracic blood index,ITBI)、血管外肺水指数(extravascular lung water index,ELWI),为PICCO组,18例患者行中心静脉穿刺后监测中心静脉压(central venous pressure,CVP),为CVP组。PICCO组根据平均动脉压(mean arterial pressure,MAP)、ITBI、ELWI指导CBP期间的容量管理。CVP组根据MAP、CVP指导CBP期间的容量管理。记录所有患者的治疗前、治疗后24h及72h的急性生理学与慢性健康状况(acute physiology and chronic health evaluation,APACHE)Ⅱ评分、氧合指数(oxygenation index,OI)、低血压发生例数、去甲肾上腺素用量及出入量。结果:PICCO组与CVP组治疗前的APACHEⅡ评分、氧合指数比较,差异无统计学意义(P0.05)。患者经CBP治疗后24h、72h时,PICCO组患者的去甲肾上腺素用量和低血压的发生率均明显低于CVP组,APACHEⅡ评分明显低于CVP组,氧合指数明显高于CVP组,差异均有统计学意义(P0.05)。PICCO组患者在0-24h、0-72h的总入量较CVP组明显少,差异有统计学意义(P0.05)。PICCO组和CVP组患者在0-24h、0-72h的液体平衡量为负平衡,同时,PICCO组患者在0-24h、0-72h的液体负平衡量明显比CVP组多(P0.05)。结论:PICCO监测指标较CVP更适用于指导重症患者CBP期间的容量管理,有利于患者稳定、顺利的进行治疗,有助于病情改善。
[Abstract]:Objective: to investigate the value of pulse indicate contour cardiac output PICCOs in guiding blood purification in severe patients.Methods: from April 2015 to September 2016, 36 patients treated with continuous blood purification blood purificationCBPs were enrolled in the prospective clinical study, which were treated by the Department of intensive Medicine of the first people's Hospital of Guiyang City from April 2015 to September 2016.The subjects were randomly divided into two groups, 18 patients were treated with central vein,After femoral artery puncture, intrathoracic blood volume index intrathoracic blood index and extravascular lung water index were monitored by PICCO volume monitor after femoral artery puncture. 18 patients in PICCO group underwent central venous pressure monitoring after central venipuncture, according to the data of CVP group.Mean arterial pressuremap-mapi guided volume management during CBP. Volume management during CBP was guided by map-CVP in the CVP group.The acute physiology and chronic health evaluation and Apache 鈪，

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