论文部分内容阅读
目的:通过对感染性休克患者进行Pi CCO监测,对比CVP与GEDVI对循环血容量的判断价值,探讨Pi CCO治疗方案在感染性休克早期液体复苏中的应用价值。方法:选取入ICU时APACHEⅡ大于15分的感染性休克患者18例,行气管插管机械通气。经锁骨下静脉置管,经股动脉置入股动脉型热稀释导管,行Pi CCO监测。Pi CCO建立即刻为T0,每小时一次热稀释测量,连续测量6小时(T1~T6)。以CI、GEDVI、EVLWI为指导,按Pi CCO治疗方案进行液体管理。结果:以GEDVI为金标准,CVP对低血容量判断的灵敏度、特异度、阳性预测值、阴性预测值分别是4%、100%、100%、64%。CVP对高血容量判断的灵敏度、特异度、阳性预测值、阴性预测值分别是17%、55%、21%、48%。CVP与CI无相关性,ΔCVP与ΔCI无相关性,CVP与GEDVI无相关性。而GEDVI与CI明显相关,ΔGEDVI与ΔCI明显相关。GEDVI与EVLWI有相关性,而CVP与EVLWI无相关性.在各时点,CI与GEDVI变化趋势基本一致,而CI与CVP变化趋势相反。结论:对于需要机械通气的感染性休克患者,CVP对低血容量判断的特异度高,但不灵敏。GEDVI能够更好的反映心脏的前负荷,对低血容量的判断敏感,更适合感染性休克病人的液体管理。Pi CCO治疗治疗方案可以避免因CVP不敏感而导致的液体复苏不足现象的发生。
OBJECTIVE: To evaluate the value of CVP and GEDVI in judging circulating blood volume by detecting Pi CCO in patients with septic shock, and to explore the value of Pi CCO treatment in early liquid resuscitation of septic shock. Methods: 18 cases of septic shock with APACHEⅡ greater than 15 were enrolled in ICU, and received mechanical ventilation of tracheal intubation. The subclavian vein catheter, the femoral artery femoral artery catheterization, Pi CCO monitoring. The Pi CCO was established immediately as T0, once per hour for the thermodilution measurement, and continuous measurement for 6 hours (T1 to T6). Guided by CI, GEDVI and EVLWI, liquid management was conducted according to Pi CCO treatment plan. Results: The sensitivity, specificity, positive predictive value and negative predictive value of CVP for determining hypovolemia were 4%, 100%, 100% and 64%, respectively, with GEDVI as the gold standard. The sensitivity, specificity, positive predictive value, and negative predictive value of CVP for high blood volume were 17%, 55%, 21% and 48%, respectively. CVP and CI no correlation, ΔCVP and ΔCI no correlation, CVP and GEDVI no correlation. However, GEDVI was significantly correlated with CI, and ΔGEDVI was significantly correlated with ΔCI. There was a correlation between GEDVI and EVLWI, but there was no correlation between CVP and EVLWI. At each time point, the trend of CI and GEDVI was basically the same, while the trend of CI and CVP was opposite. Conclusions: CVP is highly specific, but insensitive, for judging hypovolemia in patients with septic shock requiring mechanical ventilation. GEDVI can better reflect the heart’s preload, is sensitive to the judgment of hypovolemia and more suitable for the management of septic shock patients. Pi CCO treatment regimen avoids the lack of fluid recovery due to CVP insensitivity.