PiCCO监测下液体复苏治疗脓毒症休克合并重度急性呼吸窘迫综合征的价值研究

Value of PiCCO monitoring for patients with septic shock complicated with severe ARDS

摘要:

目的 探究脉搏指示连续心排血量（PiCCO）监测下液体复苏治疗脓毒症休克合并重度急性呼吸窘迫综合征（ARDS）的价值。方法 选取2019年1月—2021年12月亳州市人民医院收治的脓毒症休克合并重度ARDS患者84例为研究对象。采用随机数字表法将患者分为观察组与对照组，每组42例。两组均给予常规治疗，观察组在PiCCO监测下进行液体复苏，对照组在中心静脉压（CVP）监测下进行液体复苏。比较两组患者的达标时间、6 h及24 h达标率、输血情况、24 h补液量、使用血管活性药物时间、机械通气时间、连续肾脏替代治疗（CRRT）时间、重症监护室（ICU）治疗时间、使用抗生素时间、肺功能指标、代谢指标、60 d总生存率。结果 观察组达标时间及治疗期间输血例数低于对照组（P <0.05），观察组6 h达标率高于对照组（P <0.05）；两组24 h达标率比较，差异无统计学意义（P >0.05）；观察组24 h补液量、使用血管活性药物时间、机械通气时间、CRRT时间、ICU治疗时间、使用抗生素时间均低于对照组（P <0.05）；观察组呼吸频率、氧合指数、乳酸水平及肌酐水平治疗前后差值均高于对照组（P <0.05）；观察组与对照组存活率比较，差异无统计学意义（P >0.05）。结论 对脓毒症休克合并重度ARDS患者进行液体复苏治疗时，采用PiCCO监测有助于早期达到复苏目标，缩短患者治疗时间，改善肺功能和代谢水平。

Abstract:

Objective To explore the value of different fluid resuscitation monitoring methods in septic shock patients with severe acute respiratory distress syndrome (ARDS).Methods Eighty-four patients with septic shock and severe ARDS admitted to the emergency department of our hospital from January 2019 to December 2021 were selected as the study objects. The patients were divided into observation group and control group by random number table method, with 42 cases in each group. Both groups received routine treatment. The observation group received fluid resuscitation under the monitoring of pulse indication continuous cardiac output (PiCCO), and the control group received fluid resuscitation under the monitoring of central venous pressure (CVP). The standard time, 6 h and 24 h standard rate, blood transfusion, 24 h fluid replacement, time of using vasoactive drugs, time of mechanical ventilation, time of continuous renal replacement therapy (CRRT), time of intensive care unit (ICU), time of using antibiotics, pulmonary function index, metabolic index, and 60-day mortality were compared between the two groups were compared.Results The time of reaching the standard and the number of blood transfusions in the observation group were lower than those in the control group (P < 0.05), and the rate of reaching the standard at 6 h in the observation group was higher than that in the control group (P < 0.05). There was no significant difference in 24 h compliance rate between the observation group and the control group (P > 0.05). The 24-hour fluid replacement volume, time of using vasoactive drugs, mechanical ventilation time, CRRT time, ICU treatment time, and antibiotic use time in the observation group were all lower than those in the control group (P < 0.05). The respiratory rate, oxygenation index, lactate level, and creatinine level of the observation group were higher than those of the control group before and after treatment (P < 0.05). There was no significant difference in survival rate between the observation group and the control group (P > 0.05).Conclusion When patients with septic shock and severe acute respiratory distress syndrome are treated with fluid resuscitation, continuous cardiac output monitoring with pulse indication is helpful to achieve the resuscitation goal at an early stage, shorten the treatment time, improve lung function, and metabolic level.