内科

目的探讨利用脉搏指示连续心排血量检测仪（PICCO）检测的容量性指标指导治疗感染性休克患者的临床效果。方法选取2013年12月至2015年2月在我院ICU住院治疗的感染性休克患者36例，随机分为PICCO组和对照组各18例。PICCO组患者通过PICCO监测患者全心舒张末容积指数（GEDVI）、血管外肺水指数（EVLWI）指导液体复苏；对照组根据中心静脉压指导液体复苏。观察两组患者液体复苏前后乳酸、乳酸清除率等指标的变化。结果液体复苏后 6 h、12 h，PICCO组患者的乳酸清除率均高于对照组（P＜0.05）。治疗48 h后，两组患者APACHE-II评分显著下降（P＜0.05），PICCO组患者评分低于对照组（P＜0.05）；PICCO患者氧合指数较治疗前显著增高（P＜0.05），但两组比较差异无统计学意义；PICCO组患者BNP低于对照组（P＜0.05）。PICCO组患者48 h内输液总量低于对照组（P＜0.05），30 d病死率低于对照组（P＜0.05）。结论应用PICCO监测数据，对感染性休克患者进行液体复苏治疗，能够快速改善患者组织灌注，避免过度液体输注，能更有效地改善患者心肺功能，降低病死率。

ObjectiveTo investigate the clinical application effects of PICCO capacity index in fluid resuscitation of septic shock. MethodsA total of 36 patients with septic shock admitted to ICU in our hospital from December 2013 to February 2015 were enrolled and randomly divided into PICCO group（n=18）and control group（n=18）. The PICCO group received fluid resuscitation guided by global end-diastolic volume index (GEDVI) , extra-vascular lung water index (EVLWI) which monitoring by PICCO, while the control group received fluid resuscitation guided by central venous pressure. Lactic acid , lactate clearance rate of the two groups were observed before and after fluid resuscitation. ResultsAfter fluid resuscitation for 6 hours and 12 hours, the lactate clearance rate in PICCO group were both significantly higher than those in control group (P＜0.05).After fluid resuscitation for 48 hours, APACHE-II score in the two groups were decrease significantly compared to before fluid resuscitation, and APACHE-II score in PICCO group was significantly lower than that in control group (P＜0.05); Oxygenation index in PICCO group was significantly higher than that before fluid resuscitation, but there was no significant difference between two groups, BNP in the PICCO group was significantly lower than that in control group (P＜0.05). The total of fluid resuscitation within 48 hours in PICCO group was significantly less than that in control group, the 30-day mortality in PICCO group was significantly lower than that in control group(P＜0.05). ConclusionsFluid resuscitation in patients with septic shock monitoring by PICCO could improve tissue perfusion quickly, avoid excessive fluid infusion, improve heart and lung function effectively, and reduce mortality rate.