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目的:探讨使用脉搏波波指示连续心排血量(Pi CCO)监测仪监测合并有基础心脏病的脓毒症患者血流动力学的变化特点及临床意义。方法:将2016年2月-2017年2月收治的52例脓毒症患者依据病史及入住ICU时心脏彩色多普勒超声,根据射血分数分为A1组(有心脏基础病、EF<55%,20例)、A2组(有心脏基础病、EF≥55%,16例)、A3组(无心脏基础病、EF≥55%,16例),分别于诊断开始0、12、24、36、48、72小时利用PiCCO监测仪对胸腔内血管容量(ITBV)、血管外肺水指数(EVLW)、CI(心指数)及外周循环阻力(SVRI)进行监测,并比较三组患者治疗28天的死亡率,并将结果进行统计学分析。结果:于24小时之内A1组CI、SVRI明显低于A2、A3组,而EVLWI、ITBV明显升高(P<0.05);A2组与A3组比较,于24小时之后CI、SVRI低,EVLWI、ITBV高,差异有统计学意义(P<0.05)。A1、A2组的APACHEⅡ评分、机械通气时间与28天死亡率明显高于A3组(P<0.05)。结论:Pi CCO监测能够及时地、有效地发现合并有基础心脏病脓毒症患者休克时心功能变异及低循环动力学阶段的出现,能更好地指导合并有基础心脏病脓毒症患者液体复苏及强心药、血管活性药物等使用的时机。
Objective: To investigate the characteristics and clinical significance of hemodynamic changes in patients with sepsis complicated with primary heart disease by using PiCCO monitor. Methods: Fifty-two patients with sepsis who were admitted from February 2016 to February 2017 were divided into group A1 according to their ejection fraction and heart failure (EF <55) according to their medical history and color Doppler echocardiography. %, 20 cases), group A2 (with heart disease, EF≥55%, 16 cases), group A3 (without heart disease, EF≥55%, 16 cases), at diagnosis 0,12,24, 36, 48, and 72 hours. The intra-thoracic vascular capacity (ITBV), extravascular lung water index (EVLW), CI (cardiac index) and peripheral circulation resistance (SVRI) were monitored by PiCCO monitor. Day mortality, and the results for statistical analysis. Results: Within 24 hours, the CI and SVRI in group A1 were significantly lower than those in group A2 and group A3, while the EVLWI and ITBV were significantly increased (P <0.05); in group A2 and group A3, after 24 hours, CI, SVRI, EVLWI , ITBV high, the difference was statistically significant (P <0.05). APACHEⅡscore in A1 and A2 group, mechanical ventilation time and 28-day mortality were significantly higher than those in A3 group (P <0.05). Conclusion: Pi CCO monitoring can promptly and effectively find out the cardiac function variation and low-cycle kinetic stages of shock in patients with sepsis complicated with basic heart disease, which can better guide the patients with sepsis complicated with heart disease Recovery and cardiac drugs, vasoactive drugs, such as the use of timing.