摘要
目的探讨脉波指示连续心排血量指导下的血管外肺水指数监测在重症急性胰腺炎合并急性呼吸窘迫综合征中的应用。方法将70例重症急性胰腺炎合并急性呼吸窘迫综合征患者按照随机数字表法分为研究组与对照组,每组35例。对照组给予常规肺水管理,研究组给予脉波指示连续心排血量指导下的血管外肺水指数监测。比较两组有创通气、无创通气及总通气时间,比较两组治疗期间肺水肿、呼吸机相关性肺炎发生率及患者病死率,重症医学科住院时间、早期目标导向治疗时间、多器官功能障碍发生率。比较两组早期液体复苏1 h、6 h后相关指标水平,比较研究组早期液体复苏前、早期液体复苏1 h和6 h后无创血流动力学指标水平。结果研究组有创通气时间、无创通气时间及总通气时间均显著短于对照组(P<0.05),肺水肿、呼吸机相关性肺炎发生率及病死率均显著低于对照组(P<0.01),重症医学科住院时间及早期目标导向治疗时间显著短于对照组(P<0.01),并发症发生率、多器官功能障碍发生率显著低于对照组(P<0.05)。研究组早期液体复苏6 h后呼吸频率、血糖、乳酸水平显著低于早期液体复苏1 h后(P<0.01),尿量及pH水平显著高于早期液体复苏1 h后(P<0.01);对照组早期液体复苏6 h后呼吸频率、血糖、碱剩余、乳酸水平显著低于早期液体复苏1 h后(P<0.05或0.01),尿量、输液量、pH水平显著高于早期液体复苏1 h后(P<0.01)。研究组早期液体复苏1 h后输液量、pH、碱剩余水平均显著高于对照组(P<0.01),乳酸水平显著低于对照组(P<0.01);早期液体复苏6 h后尿量、pH水平均显著高于对照组(P<0.01),呼吸频率、心率、乳酸水平均显著低于对照组(P<0.05或0.01)。研究组早期液体复苏6 h后心输出量水平与早期液体复苏1 h后比较差异无统计学意义(P>0.05),心输出量指数、每搏输出量水平显著低于早期液�
Objective To explore the application value of extravascular lung water index(EVLWI)guided by pulse indicator continous cadiac output(PICCO)in severe acute pancreatitis(SAP)combined with acute respiratory distress syndrome(ARDS).Methods A total of 70 patients with SAP complicated with ARDS were randomly divided into study group and control group according to random number table method,with 35 cases in each group.The control group was given routine lung water management,and the study group was given PICCO guided lung water management.The duration of invasive ventilation,non-invasive ventilation and total ventilation were compared between the two groups.The incidence of pulmonary edema,ventilator associated pneumonia(VAP),mortality,intensive care unit(ICU)hospitalization time,early goal directed therapy(EGDT)time,and the incidence of multiple organ dysfunction syndrome(MODS)were compared between the two groups.The levels of related indicators were compared between the two groups 1 h and 6 h after early fluid resuscitation.The noninvasive hemodynamic indexes of the study group were compared before early fluid resuscitation and 1 h and 6 h after early fluid resuscitation.Results The duration of invasive ventilation,non-invasive ventilation and total ventilation in the study group were significantly shorter than those in the control group(P<0.05).The incidence of pulmonary edema,VAP and mortality were significantly lower than those of the control group(P<0.01),the ICU hospitalization time and EGDT time were significantly shorter than those of the control group(P<0.01),and the incidence of complications and MODS were significantly lower than those of the control group(P<0.05).The respiratory rate(RR),glucose(GLU)and lactic acid levels in the study group after 6 h of early fluid resuscitation were significantly lower than those after 1 h of early fluid resuscitation(P<0.01).Urine volume and pH level were significantly higher than those after 1 h of early fluid resuscitation(P<0.01).The RR,GLU,buffuer excess(BE)and lactic
作者
何亚丽
刘宏
祁家祥
He Yali;Liu Hong;Qi Jiaxiang(Pingdingshan First People's Hospital,Pingdingshan 467000,Henan,China)
出处
《临床心身疾病杂志》
CAS
2021年第5期36-41,共6页
Journal of Clinical Psychosomatic Diseases
基金
河南省医学科技攻关计划项目(编号2018062118)。
