Analysis of improvement function of fluid management and prognosis in patients with septic shock complicated with acute respiratory distress syndrome by PICCO technology
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摘要: 目的: 探究脉搏指示连续心排血量监测技术(PICCO)对指导感染性休克合并ARDS患者液体复苏的应用价值及对其预后的影响。方法: 选取2016-06-2018-01期间入我院ICU治疗的感染性休克并ARDS患者60例,随机分为观察组(30例)和对照组(30例),观察组采取PICCO进行液体管理,对照组采取常规液体管理方式。比较两组患者心肺功能指标、血流动力学指标、液体复苏相关指标及预后情况。结果: 观察组液体复苏后心肺功能指标优于对照组(CI、GEDVI、GEF、氧合指数较对照组升高,EVLWI较对照组降低),差异有统计学意义(P<0.05);观察组患者液体复苏后血流动力学指标较对照组改善更显著(MAP、CVP、SVRI较对照组升高,PVRI较对照组降低),差异有统计学意义(P<0.05);观察组复苏24 h时,液体入量、尿量要显著的高于对照组,差异有统计学意义(P<0.05)。液体复苏3 d时,观察组血管活性药物用量低于对照组,LAC水平低于对照组,差异有统计学意义(P<0.05);观察组患者机械通气时间、入ICU时间较对照组缩短,APACHEⅡ评分较对照组降低,28 d病死率较对照组降低,差异有统计学意义(P<0.05)。结论: PICCO在指导感染性休克并ARDS患者液体复苏方面较传统CVP监测技术更为精确,能够在短时间内有效纠正休克状态、提高心肺功能、改善预后、降低病死率,值得在ICU中推广。Abstract: Objective: To explore the application value of Pulse Indicator Continuous Cardiac Output Monitoring(PICCO) in guiding fluid resuscitation in patients with septic shock complicated with ARDS and its effect on prognosis. Method: 60 cases of patients with septic shock and ARDS admitted to ICU in our hospital from June 2016 to January 2018 were selected and randomly divided into the observation group(30 cases) and the control group(30 cases). The patients in the observation group were treated with PICCO for liquid management while those in the control group were treated with conventional liquid management. The indexes of cardiopulmonary function, hemodynamics, fluid resuscitation and prognosis were compared between the two groups. Result: After fluid resuscitation, cardiopulmonary function indexes in the observation group were better than those in the control group(CI, GEDVI, GEF, oxygenation indexes were higher than those in the control group, while EVLWI was lower than those in the control group). The difference was statistically significant(P<0.05), and the homodynamic indexes of the patients in the observation group were improved more significantly than those in the control group(MAP, CVP, SVRI were higher than those in the control group, and PVRI was lower than those in the control group), and the difference was statistically significant(P<0.05). 24 hours after resuscitation, the fluid intake and urine volume in the observation group were significantly higher than those in the control group, and the difference was statistically significant(P<0.05). 3 days of fluid resuscitation, the dosage of vasoactive drugs in the observation group was lower than that in the control group, and the level of LAC was lower than that in the control group. The difference was statistically significant(P<0.05). The time of mechanical ventilation and ICU entry in the observation group was shorter than those in the control group, and APACHE II score was lower than that in the control group and the 28-day mortality rate was lower than that in the control group. The difference was statistically significant(P<0.05).Conclusion: PICCO is more accurate than traditional CVP monitoring technology in guiding fluid resuscitation in patients with septic shock and ARDS. It can effectively correct shock state, improve cardiopulmonary function, improve prognosis and reduce mortality in a short time, which is worth popularizing in ICU.
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Key words:
- PICCO /
- septic shock /
- ARDS /
- fluid resuscitation
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