摘要
目的:研究PICCO监测对脓毒症休克合并ARDS患者目标导向液体复苏及疗效评价的临床价值。方法:计算机检索Pubmed、The Cochrane Library、Embase、中国知网、中国生物医学数据库、万方及维普数据库,检索时限均从建库至2022年8月15日。研究者按照纳入及排除标准,筛选文献、提取资料、评价纳入文献方法质量,采用RevMan5.4.1软件分析。结果:共纳入20项研究,涉及1652例患者。Meta分析结果:PICCO组液体复苏后APACHE-Ⅱ评分(SMD=-0.99,95%CI:-1.49~-0.49,P<0.001)及SOFA评分(SMD=-0.62,95%CI:-1.23~-0.02,P<0.001)更低;ICU住院日(OR=-1.15,95%CI:-1.47~-0.82,P<0.001)及机械通气时间(OR=-1.74,95%CI:-2.26~-1.23,P<0.001)缩短;液体复苏的达标率更高(OR=3.29,95%CI:2.35~4.61,P<0.001)、血管外肺水更少(SMD=-0.75,95%CI:-1.06~-0.44,P<0.001)、尿量更多(SMD=1.56,95%CI:0.92~2.19,P<0.001)、去甲肾上腺素剂量更少(SMD=-0.95,95%CI:-1.60~-0.30,P=0.004);氧合改善更显著(SMD=0.86,95%CI:0.58~1.15,P<0.001)、并发症风险(OR=0.39,95%CI:0.22~0.71,P=0.002)及病死率更低(OR=0.36,95%CI:0.27~0.48,P<0.001)。结论:PICCO监测对脓毒症休克合并ARDS患者复苏疗效显著,可显著改善氧合、缩短ICU住院日及机械通气时间,并发症更少且病死率更低,具有较高的临床运用价值。
Objective:To investigate the clinical value of pulse⁃indicated continuous cardiac output(PIC⁃CO)monitoring for the efficacy evaluation of goal⁃directed fluid resuscitation in the cases of septic shock with acute respiratory distress syndrome(ARDS).Methods:Literature retrieval was done in the Pubmed,the Cochrane Library,Embase,CNKI,CBM,WanFang,and VIP databases from the date of establishment to August 15th,2022.According to the inclusion and exclusion criteria,re⁃searchers independently screened out all the literature,extracted data,and evaluated the quality of the included literature.RevMan 5.4.1 software was then used for statistical analysis.Results:A total of 20 studies involving 1652 patients were included.Meta⁃analysis indicated that APACHE⁃Ⅱscore(SMD=-0.99,95%CI:-1.49⁃-0.49,P<0.001)and SOFA score(SMD=-0.62,95%CI:-1.23⁃-0.02,P<0.001)were lower in PICCO group after fluid resuscitation.In addition,the PICCO group tended to have shorter hospitalization(OR=-1.15,95%CI:-1.47⁃-0.82,P<0.001)and mechanical ventilation time(OR=-1.74,95%CI:-2.26⁃-1.23,P<0.001)in ICU.What's more,the qualified rate of goal⁃directed fluid resuscitation in PICCO group was superior than in control group(OR=3.29,95%CI:2.35⁃4.61,P<0.001)with less EVLW(SMD=-0.75,95%CI:-1.06⁃-0.44,P<0.001),more urine(SMD=1.56,95%CI:0.92⁃2.19,P<0.001),and less Norepinephrine(SMD=-0.95,95%CI:-1.60⁃-0.30,P=0.004).PICCO group also demonstrated for higher oxygenation index(SMD=0.86,95%CI:0.58⁃1.15,P<0.001),fewer complication rate(OR=0.39,95%CI:0.22⁃0.71,P=0.002)and lower mortality rate(OR=0.36,95%CI:0.27⁃0.48,P<0.001).Conclusion:PICCO monitoring is of vital clinical applied value for sepsis shock complicated with ARDS patients,not only for better improvement of oxygenation but al⁃so for shortening ICU hospitalization and mechanical ventilation time,fewer complications,and lower mortality.
作者
柳舟
张亮
王璐
李镇文
袁敏
李鄂安
朱昌金
詹丽英
LIU Zhou;ZHANG Liang;WANG Lu;LI Zhenwen;YUAN Min;LI E'an;ZHU Changjin;ZHAN Liying(Dept.of Critical Care Medicine,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;Dept.of Radiology,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;Dept.of anesthesiology,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;Dept.of Critical Care Medicine,People's Hospital of Wuhan Economic and Technological Development Zone(Hannan Zone),Wuhan 430090,Hubei,China;Dept.of Critical Care Medicine,People's Hospital of Shayang County,Jingmen 448200,Hubei,China)
出处
《武汉大学学报（医学版）》
CAS
2023年第11期1361-1370,共10页
Medical Journal of Wuhan University
基金
国家重点研发计划项目(编号:2021YFC2501800)。
