Objective To observe the clinical effect of pulse indicator for continuous cardiac output (PiCCO) for monitoring guide of liquid management in patients with severe sepsis complicated with pulmonary injury.Methods 95 patients with severe sepsis and pulmonary injury were randomly divided into two groups, control group (n=47) and observation group (n=48), patients in control group were administrated with conventional liquid management after admission, and pateints in observation group were applied with PiCCO monitor for guidance of liquid management after admission to the hospital.The effects of patients in these two groups with liquid management and outcome were compared.Results The heart rate (HR), central venous pressure (CVP), mean arterial pressure (MAP), blood level of lactic acid, urine, active blood vessel strength scores (VIS) and acute physiology and chronic health evaluation (APACHE Ⅱ) in patients of these 2 groups after treatment for 3 days were significantly improved than those before treatment (P0.05).The duration for mechanical ventilation, duration for application of vascular active drugs, duration for ICU stay, mortality of 28 days in observation group were significantly lower than those of control group (P0.05);观察组入住ICU时间、血管活性药物使用时间、机械通气时间、28d病死率均明显低于对照组(P<0.05);两组患者治疗3 d后的脑钠肽(BNP)、血清肌酐(Scr)、脑钠肽(BNP)、降钙素原(PCT)均较治疗前显著降低(P<0.05),观察组患者治疗后3 d的BNP、Scr、PCT均显著低于对照组,差异有统计学意义(P<0.05).结论 在PiCCO监测指导下应用液体管理治疗严重脓毒症合并肺损伤患者效果理想,较常规液体管理更有利于保护心、肾等主要脏器功能,提高临床中的液体管理质量,建议临床推广.
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