摘要
目的评价脉搏指示连续心排血量监测（PiCCO）技术优化脓毒性休克患者早期目标指导治疗（EGDT）的效果。方法脓毒性休克患者40例，年龄25～75岁，急性生理及慢性健康评分10～40分，采用随机数字表法，将其分为2组（n=20）：常规EGI）T（C组）和PiCCO优化EGDT组（P组）。C组维持CVP8～12mmHg，MAP≥65mmHg，中心静脉氧饱和度≥70％。P组于股动脉置人PiCCO监测导管，根据全心舒张末期容积指数并结合CVP指导补液，维持全心舒张末期容积指数650～800ml／m2；调整多巴酚丁胺用量，维持每搏输出量指数40～60ml／m＾2齐心室收缩力指数l200～2000mmHg／s；调整多巴胺用量，维持外周血管阻力指数1200～1800dyne·s·cm＾-5·m＾-2，MAPI≥65mmHg。记录6hEGDT达标情况，复苏6h时记录Lac水平和中心静脉．动脉血二氧化碳分压差（Pv-aC02）和尿量；复苏6、24和48h时液体正平衡量、多巴胺和多巴酚丁胺累积用量；记录机械通气时间、ICU停留时间及复苏开始后28d生存情况。结果与C组相比，P组复苏6h时Lac和Pv-aCO2降低，复苏6、24h时液体正平衡量和多巴酚丁胺累积用量升高，复苏6、24和48h时多巴胺累积用量降低，机械通气时间和ICU停留时间缩短（P〈0．05或0．01），6hEGDT达标率、尿量和28d生存率差异无统计学意义（P〉0．05）。结论PiCCO技术对脓毒性休克患者EGDT无显著优化效果。
Objective To evaluate the efficacy of pulse-indicated continuous cardiac output （PiCCO） tot optimizing early goal-directed therapy （EGDT） in patients with septic shock. Methods Forty patients with septic shock, aged 25-75 yr, with acute physiology and chronic health evaluation score of 10-40, were divided into 2 groups （n = 20 each） using a random number table： conventional EGDT group （group C） and optimized EGDT guided by PiCCO group （P group）. In group C, CVP was maintained at 8-12 mmHg, MAP t〉65 mmHg, and central venous oxygen saturations〉 70%. In P group, a catheter was inserted into the femoral artery for PiCCO monitoring, fluid was replaced according to global end-diastolic volume index （GEDVI） combined with CVP and GEDVI was maintained between 650-800 ml/m^2 . The consumption of dobutamine was adjusted to maintain stroke volume index （SVI） between 40-60 ml/m^2 , and left ventricular systolic force index between 1 200-2 000 mmHg/s. The consumption of dopamine was adjusted to maintain peripheral vascular resistance index between 1 200-1 800 dyne·s· cm^-5m^-2 , and MAP ≥65 mmHg. EGDT achieving the standard at 6 h was recorded, and lactic acid level, arterial-venous carbon dioxide tension difference （Pv-aCO2） and urine volume were recorded at 6 h of resuscitation. At 6, 24 and 48 h of resuscitation, the positive fluid balance and cumulative consumption of dopamine and dobutamine were recorded. Mechanical ventilation time, duration of ICU stay and survival rates within 28 days after start of resuscitation were recorded. Results Compared with group C, the lactic acid level and Pv-aCO2 were significantly decreased at 6 h of resuscitation, the positive fluid balance and cumulative consumption of dobutamine were increased at 6 and 24 h of resuscitation, the cumulative, consumption of dopamine was decreased at 6, 24 and 48 h of resuscitation, mechanical ventilation time and duration of ICU stay were shortened; and no significant change was found in EGDT achieving the standar
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2014年第6期739-742,共4页
Chinese Journal of Anesthesiology
基金
山东省医药卫生科技发展计划项目（2009HZll2）
关键词
监测
生理学
休克
脓毒性
早期目标指导治疗
Monitoring, physiologic
Shock, septic
Early goal＇directed therapy
