PICCO和CVP监测在脓毒性休克并发心功能不全患者治疗中的应用价值

doi:10.13481/j.1671-587x.20180526

吉林大学学报(医学版) ›› 2018, Vol. 44 ›› Issue (05): 1030-1035.doi: 10.13481/j.1671-587x.20180526

PICCO和CVP监测在脓毒性休克并发心功能不全患者治疗中的应用价值

何莲, 聂斌

贵州省贵阳市第二人民医院重症医学科, 贵州贵阳 550081

收稿日期:2018-03-05 出版日期:2018-09-28 发布日期:2018-11-20
通讯作者: 何莲,副主任医师(Tel:0851-87993821,E-mail:2658943064@qq.com) E-mail:2658943064@qq.com
作者简介:何莲(1974-),女,贵州省毕节市人,副主任医师,医学硕士,主要从事ICU重症医学方面的研究。
基金资助:
贵州省教育厅省长资金自然科学类项目资助课题[筑省专合字（2012）125号]

Application value of PICCO and CVP monitoring in treatment of patients with septic shock complicated with cardiac insufficiency

HE Lian, NIE Bin

Department of Critical Care Medicine, Guiyang Second People's Hospital, Guizhou Province, Guizhou 550081, China

Received:2018-03-05 Online:2018-09-28 Published:2018-11-20

摘要/Abstract

摘要： 目的：探讨脉搏指示连续心排血量（PICCO）和中心静脉压（CVP）监测下脓毒性休克并发心功能不全患者的治疗效果，阐明PICCO和CVP监测的临床意义。方法：137例脓毒性休克并发心功能不全患者随机分为CVP组（68例）和PICCO组（69例）。CVP组进行CVP监测指导治疗，PICCO组进行PICCO监测指导治疗。分别检测2组患者治疗前及治疗6、24和48 h后乳酸及B型脑钠肽（BNP）水平、中心静脉血氧饱和度（ScvO₂）、心率（HR）、平均动脉压（MAP）和CVP，记录PICCO组患者血流动力学参数，分别记录2组患者血管活性药物使用时间、ICU住院时间、多器官功能障碍综合征（MODS）发生率、机械通气时间和28 d死亡率。结果：与CVP组比较，PICCO组患者治疗6、24和48 h后乳酸和BNP水平及HR均明显降低（P<0.05），乳酸清除率、ScvO₂、MAP和CVP均明显升高（P<0.05）；PICCO组MAP水平明显高于同时间点CVP组（P<0.05），ScvO₂在治疗48 h后明显高于同时间点CVP组（P<0.05），而2组患者CVP水平同时间点比较差异无统计学意义（P>0.05）；2组患者MODS发生率和28 d死亡率比较差异均无统计学意义（P>0.05），但PICCO组患者血管活性药物使用时间、ICU住院时间和机械通气时间均明显短于CVP组（P<0.05）。结论：PICCO监测指导治疗脓毒性休克并发心功能不全优于CVP的监测，具有积极的临床意义。

关键词: 脉搏指示连续心排血量, 中心静脉压, 脓毒性休克, 心功能不全

Abstract: Objective:To investigate the efficacies of pulsed continuous cardiac output (PICCO) and central venous pressure (CVP) monitoring in the treatment of the patients with sepsis shock complicated with cardiac insufficiency, and to clarify the clinical significance of PICCO and CVP monitoring. Methods:A total of 137 cases of septic shock combined with cardiac insufficiency patients were randomly divided into CVP group (n=68) and PICCO group (n=69). The patients in CVP group were treated with CVP monitoring to guide therapy, and the patients in PICCO group were treated with PICCO monitoring to guide therapy.The levels of lactic acid and B brain natriuretic peptide (BNP), central venous oxygen saturation (ScvO₂), heart rate (HR), mean arterial pressure (MAP) and CVP of the patients in two groups were detected before treatment and 6, 24, 48 h after treatment, respectively; the hemodynamic parameters of the patients of PICCO group were recorded; the vasoactive drug use time,the ICU hospitalization time, the incidence rates of multiple organ dysfunction syndrome (MODS), the mechanical ventilation time and the 28 d-mortality rates of the patients were recorded. Results:Compared with CVP group, the levels lactic acid and BNP and HR of the patients in PICCO group at 6, 24, and 48 h after treatment were significantly decreased (P<0.05), and the scavenging rates of lactic acid were significantly increased(P<0.05); the levels of ScvO₂, MAP and CVP were significantly increased (P<0.05). The levels of MAP of the patients in PICCO group were significantly higher than those in CVP group at the same time(P<0.05), after 48 h of treatment, the ScvO₂ levels in PICCO group were significantly higher than those in CVP group at the same time(P<0.05), but there was no significant difference in the CVP levels of the patients between two groups at the same time (P>0.05). There were no significant differences in the incidence rates of MODS and 28 d-mortality rates between two groups(P>0.05); however the use time of vasoactive drugs, the ICU hospitalization time and the mechanical ventilation time of the patients in PICCO group were significantly shorter than those in CVP group (P<0.05). Conclusion:PICCO monitoring guides the treatment of septic shock complicated with cardiac insufficiency better than CVP monitoring, and has positive clinical significance.

Key words: pulse indicator continuous cardiac output, central venous pressure, septic shock, cardiac insufficiency

中图分类号:

R459.7

何莲, 聂斌. PICCO和CVP监测在脓毒性休克并发心功能不全患者治疗中的应用价值[J]. 吉林大学学报(医学版), 2018, 44(05): 1030-1035.

HE Lian, NIE Bin. Application value of PICCO and CVP monitoring in treatment of patients with septic shock complicated with cardiac insufficiency[J]. Journal of Jilin University(Medicine Edition), 2018, 44(05): 1030-1035.

参考文献

[1] Kaukonen KM, Bailey M, Suzuki S, et al. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012[J]. JAMA, 2014, 311(13):1308.
[2] 张友华, 吕光宇, 张磊,等. 早期液体复苏对脓毒性休克患者心肌损伤及预后的影响[J]. 现代中西医结合杂志, 2016, 25(1):43-45.
[3] 熊杰, 黄素芳, 李树生,等. 联合应用中心静脉压及氧输送监测指导脓毒性休克液体复苏的疗效观察[J]. 中华现代护理杂志, 2010, 16(5):551-552.
[4] 朱玉菡, 沈晓旭, 江其敏,等. 脉搏指示连续心排血量监测指导脓毒性休克患者治疗效果的Meta分析[J]. 中国循证医学杂志, 2017,17(8):934-940.
[5] Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3)[J]. J Am Med Assoc,2016, 315(8):775-787.
[6] 高戈, 冯喆. 外科脓毒症及脓毒性休克现状与展望[J]. 中华实验外科杂志, 2015, 32(2):232-234.
[7] 伊敏, 么改琦, 郭向阳. 脉搏指示连续心排血量监测下脓毒性休克患者心功能变化的前瞻性研究[J]. 中华危重病急救医学, 2015, 27(1):22-27.
[8] Devasia T, Kareem H, Kumar YGA, et al. Cardiac dysfunction in patients with sepsis, severe sepsis and septic shock[J]. Br J Med Med Res, 2015, 5(4):427-433.
[9] Dellinger RP1, Levy MM, Rhodes A,et al.Surviving sepsis campaign:international guidelines for management of severe sepsis and septic shock:2012[J].Crit Care Med, 2013,41(2):580-637.
[10] 中华医学会重症医学分会. 中国严重脓毒症/脓毒性休克治疗指南(2014)[J]. 中华内科杂志, 2015, 54(6):401-426.
[11] Seckel MA, Ahrens T. Challenges in sepsis care:New sepsis definitions and fluid resuscitation beyond the central venous pressure[J]. Crit Care Nurs Clin North Am, 2016, 28(4):513-532.
[12] Sasai T, Tokioka H, Fukushima T, et al. Reliability of central venous pressure to assess left ventricular preload for fluid resuscitation in patients with septic shock[J]. J Intensive Care, 2014, 2(1):58-62.
[13] Lin X, Xu Z, Wang P, et al. Role of PiCCO monitoring for the integrated management of neurogenic pulmonary edema following traumatic brain injury:A case report and literature review[J]. Exp Ther Med, 2016, 12(4):2341.
[14] 王剑彬, 王华, 陈启康,等. 中心静脉压、全心舒张末期容积指数和血管外肺水指数在评估脓毒性休克液体复苏中的作用[J]. 南方医科大学学报, 2014, 34(9):1334-1336.
[15] 黄河, 黎清标. 脉搏指示连续心排血量监测在治疗脓毒症休克合并心功能不全中的应用[J]. 广东医学, 2014, 35(6):883-885.
[16] Wanhua Y, Haiying WU, Hongze Z, et al. Prognostic value of Picco monitoring combined with plasma microRNA-150 detection in septic shock patients[J]. Zhejiang Da Xue Xue Bao Yi Xue Ban, 2015, 44(6):659-664.
[17] Cheng ZJ, Liang YQ, Emergency DO, et al. The cardiac function assessment and prognostic value of BNP level monitoring for patients with severe infection and septic shock[J]. Med Recapitulate, 2015, 14(5):326-375.
[18] Yan HP, LuXL, Qiu J, et al. Value of blood lactic acid in evaluating disease severity and prognosis in children with sepsis[J]. Zhongguo Dang Dai Er Ke Za Zhi, 2016, 18(6):506-510.
[19] 马国营, 李敬, 王维展. 乳酸清除率在脓毒性休克中的临床价值研究进展[J]. 中国中西医结合急救杂志, 2015, 22(5):554-556.
[20] 陆程翔, 孙德军, 邱婷. 乳酸清除率对感染性创面致严重脓毒症及脓毒性休克患者治疗效果及预后的评估作用[J]. 临床荟萃, 2015, 30(10):1152-1155.

PICCO和CVP监测在脓毒性休克并发心功能不全患者治疗中的应用价值

Application value of PICCO and CVP monitoring in treatment of patients with septic shock complicated with cardiac insufficiency

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