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目的分析脉搏指示连续心排出量(Pi CCO)监测指导严重脓毒症合并肺损伤患者液体管理的临床价值。方法将120例严重脓毒症合并急性肺损伤患者,随机分为观察组与对照组各60例。对照组患者入院后依据中心静脉压(CVP)与血乳酸(Lac)浓度综合评估给予常规液体管理。观察组患者入院后行Pi CCO监测指导患者液体复苏管理。对比2组天门冬氨酸氨基转移酶(AST)、肌酐(Scr)、尿素氮(BUN)、血小板计数(PLT)、脑钠肽(BNP)、降钙素原(PCT)水平变化,对比观察2组患者气管插管发生率、机械辅助通气支持时间、ICU住院时间、ICU住院费用、临床病死率差异。结果治疗前2组AST、Scr、BUN、PLT、BNP、PCT水平差异无统计学意义(P>0.05)。治疗后2组AST、Scr、BUN、BNP、PCT明显降低,PLT水平升高,且观察组波动幅度大于对照组,差异有统计学意义(P<0.05)。观察组气管插管发生率和临床病死率低于对照组,机械辅助通气支持时间、ICU住院时间短于对照组,ICU住院费用少于对照组,差异均有统计学意义(P<0.05)。结论严重脓毒症合并急性肺损伤患者早期实施液体管理策略有助于临床痊愈,Pi CCO监测指导严重脓毒症合并急性肺损伤患者早期实施液体管理效果优于传统容量指标,值得临床推广使用。
Objective To analyze the clinical value of pulse-controlled continuous cardiac output (Pi CCO) monitoring for fluid management in patients with severe sepsis and lung injury. Methods 120 patients with severe sepsis and acute lung injury were randomly divided into observation group and control group, 60 cases each. Patients in the control group were given routine fluid management based on a comprehensive assessment of central venous pressure (CVP) and lactic acid (Lac) concentration after admission. Patients in the observation group underwent Pi CCO monitoring to guide patients’ fluid resuscitation management after admission. The changes of aspartate aminotransferase (AST), creatinine (BUN), platelet count (PLT), brain natriuretic peptide (BNP) and procalcitonin (PCT) The incidence of tracheal intubation, mechanical ventilation support time, ICU stay, ICU hospitalization costs, and clinical mortality were compared between the two groups. Results There was no significant difference in AST, Scr, BUN, PLT, BNP and PCT between the two groups before treatment (P> 0.05). After treatment, the levels of AST, Scr, BUN, BNP and PCT in the two groups were significantly decreased, PLT levels were increased, and the fluctuation range of the observation group was larger than that of the control group (P <0.05). The incidence of tracheal intubation and clinical mortality in the observation group were lower than those in the control group, mechanical supportive ventilation support time, hospital stay in ICU was shorter than that in control group, ICU hospitalization costs were less than those in control group, the difference was statistically significant (P <0.05). Conclusion The early implementation of liquid management strategy in patients with severe sepsis and acute lung injury is helpful for clinical recovery. The early implementation of liquid management by patients with severe sepsis and acute lung injury guided by Pi CCO is better than the traditional capacity indicators, which is worthy of clinical promotion.