摘要
目的探讨脉搏指示剂连续心排血量监测技术(PiCCO)和床旁动态超声对重症肺炎合并急性呼吸窘迫综合征(ARDS)患者治疗的临床价值的对比研究。方法选择20例重症肺炎合并ARDS患者为研究对象(A组),采用PiCCO动态监测全心射血分数(GEF)、全心舒张末期容积(GEDV)、胸腔内血容量(ITBV)、血管外肺水指数(EVLW)等指标,以同期20例重症肺炎合并ARDS患者为对照组(B组),通过床旁动态超声监测左心室舒张末期容积(LVEDV)、血流速度时间积分(VTI)、左心室每搏量(SV)、心输出量指数(CI)和肺水肿等指标,2组患者入院时密切监测其生理指标、血乳酸(Lac)、氧合指数(PaO_(2)/FiO_(2))以及平均动脉压(MAP)和液体量等情况,评价患者机械通气时间、ICU住院时间和28 d预后情况。结果A组治疗后CI、GEDV、ITBV、EVLW等血流动力学指标明显改善,B组治疗后SV、LVEDV等指标也有改善(P<0.05)。A组患者机械通气时间和ICU住院时间明显低于B组(P<0.05),2组28 d病死率差异无统计学意义(P>0.05)。结论重症肺炎合并ARDS患者采用PiCCO技术指导治疗较床旁动态超声明显缩短患者机械通气时间和ICU住院时间。
Objective To explore the efficacy observation of pulse indicator continuous cardiac output monitoring(PiCCO)combined with ultrasound in fluid resuscitation of patients with severe pneumonia combined with ARDS.Methods Twenty patients with severe pneumonia combined with Acute Respiratory Distress Syndrome(ARDS)were selected as the study subjects(Group A),and PiCCO was used to dynamically monitor the whole-heart ejection fraction(GEF),whole-heart end-diastolic volume(GEDV),intrathoracic blood volume(ITBV),extravascular lung water index(EVLW),etc.In the control group(Group B),20 patients with recent severe pneumonia combined with ARDS were monitored by bedside ultrasound for left ventricular end-diastolic volume(LVEDV),velocity time integral(VTI),left ventricular volume per beat(SV),and cardiac output index(CI),etc.In both groups,physiological indexes,blood lactate(Lac),oxygenation index(PaO_(2)/FiO_(2))as well as mean arterial pressure(MAP)and fluid volume were closely monitored at the time of admission to evaluate the prognosis of the patients.Results Hemodynamic indexes such as CI,GEDVI,ITBVI,EVLWI improved significantly after treatment in group A,and SV,LVEDV also improved after treatment in group B(P<0.05).The duration of mechanical ventilation and ICU hospitalization was significantly lower in group A than in group B(P<0.05).The difference in morbidity and mortality rates between the two groups was not statistically significant(P>0.05).Conclusion The patients with severe pneumonia combined with ARDS are monitored by PiCCO technology,and the guided treatment could significantly shorten the patients′mechanical ventilation time and ICU treatment time compared with bedside ultrasound.
作者
白吉佳
郑磊
朱金源
范玉燕
杨晶
黑琴琴
赵恬
马希刚
BAI Jijia;ZHENG Lei;ZHU Jinyuan;FAN Yuyan;YANG Jing;HEI Qinqin;ZHAO Tian;MA Xigang(Department of Critical Care Medicine,General Hospital of Ningxia Medical University,Yinchuan 750004,China;The Second People′s Hospital of Dawukou District,Shizuishan 753000,China)
出处
《宁夏医学杂志》
CAS
2024年第3期202-205,共4页
Ningxia Medical Journal
基金
宁夏科技厅重点研发项目(2020BEG03012)
宁夏医科大学校级项目(XM2020143)。
