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目的探讨脉搏轮廓温度稀释连续心排量测量技术(PICCO)监测在重症感染患者早期液体复苏治疗(EGDT)中的临床应用。方法选择60例重症感染及感染性休克患者,应用PICCO监测技术进行床旁血流动力学监测,并根据监测指标指导患者液体复苏,记录患者HR、MAP、CVP、CI、SVV、ELWI、ITBI、GEDI液体复苏前后的变化。同时监测复苏前、复苏6 h及24 h后中心静脉血气分析、乳酸及碱剩余值及急性生理和慢性健康评分(APACHEⅡ)。结果应用PICCO监测血流动力学指标,发现MAP、CVP、CI、ITBI、GEDI均增高(P<0.05);SVV下降(P<0.05);而ELWI无明显增加(P>0.05)。复苏24 h乳酸清除率、ScvO_2、碱剩余及急性生理和慢性健康评分较复苏前有明显差异(P<0.01)。存活组EGDT达标比率远远高于死亡组。结论 PICCO血流动力学监测技术在重症感染及感染性休克患者早期液体复苏治疗中发挥着重要的作用。
Objective To investigate the clinical application of PICCO monitoring in early liquid resuscitation (EGDT) in patients with severe infection. Methods Sixty patients with severe sepsis and septic shock were selected. The bedside hemodynamic monitoring was performed with PICCO and the patients were resuscitated according to the monitoring indexes. The HR, MAP, CVP, CI, SVV, ELWI, ITBI, Changes of GEDI liquid before and after resuscitation. Central venous blood gas analysis, lactic acid and alkali remnant, and acute physiology and chronic health score (APACHE II) were also monitored before resuscitation, 6 h and 24 h after resuscitation. Results Using PICCO to monitor the hemodynamic parameters, MAP, CVP, CI, ITBI and GEDI were all increased (P <0.05); SVV was decreased (P <0.05); ELWI was no significant difference (P> 0.05). The 24 h recovery rate of lactic acid, ScvO_2, alkali residual and acute physiological and chronic health scores were significantly different from those before resuscitation (P <0.01). Survival group EGDT compliance rate is much higher than the death group. Conclusion The PICCO hemodynamic monitoring technique plays an important role in early liquid resuscitation in patients with severe infection and septic shock.