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目的:探讨监测其脉搏指示连续心排血量(Pi CCO)对脓毒性休克患者临床治疗的意义。方法:选取2014年3月至2016年9月来海南省万宁市人民医院、广东省人民医院治疗的126例脓毒性休克患者,随机分配为观察组患者63例,对照组患者63例,观察组患者监测Pi CCO,对照组患者采用传统监测方式,记录观察组和对照组患者进入重症监护病房(ICU)治疗后6 h、3 d后体内的液体总量、急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ)及患者刚进ICU时和治疗3 d后血浆氨基酸B型钠尿肽前体(NT-pro-BNP)和中心静脉压(CVP)的差值,两组使用呼吸机进行机械通气、住重症病房天数,28 d内的病死率,并对以上参数进行分析比较。结果:观察组患者在治疗3 d后APACHEⅡ评分、呼吸机支持时间、住院天数均小于对照组,住院3 d后的前后水平差值NT-pro-BNP大于对照组,差值CVP小于对照组,差异具有统计学意义(P<0.05)。两组6 h补液量、3 d补液量、28 d内病死率对比,差异均无统计学意义(P>0.05)。结论:监测Pi CCO结合早期目标导向治疗(EGDT)能够有效指导临床精确治疗,缩短患者住ICU及使用呼吸机的时间。
Objective: To investigate the clinical significance of monitoring the PiCCO in patients with septic shock. METHODS: A total of 126 patients with septic shock who were treated in Wanning People’s Hospital of Hainan Province and Guangdong Provincial People’s Hospital from March 2014 to September 2016 were randomly assigned to observation group (n = 63) and control group (n = 63) The patients were monitored by Pi CCO. The patients in the control group were treated with traditional monitoring methods. The total body fluid volume, acute physiology and chronic health status scores of the observation group and the control group after 6 h and 3 d of ICU were recorded (APACHEⅡ), and the differences of plasma A-B-NPP and CVP between the first ICU and the third day of treatment, the two groups were ventilated with ventilator, Live ward days, 28 d mortality, and the above parameters were analyzed and compared. Results: APACHEⅡscore, ventilator support time and hospitalization days in the observation group were less than those in the control group after 3 days of treatment. NT-pro-BNP level difference in the 3 days after hospitalization was greater than that in the control group, CVP was lower than the control group, The difference was statistically significant (P <0.05). There was no significant difference in the 6 h fluid rehydration volume, 3 d rehydration volume, and 28 d mortality (P> 0.05). CONCLUSIONS: Monitoring PiCCO combined with early target-directed therapy (EGDT) can effectively guide clinical accurate treatment and shorten the duration of ICU and ventilator use.