脉搏指示连续心搏出量检测技术对严重肺部感染合并心力衰竭患者预后的影响

摘要

Objective:To evaluate the short-term effect of pulse indicator continuous cardiac output (PiCCO)-guided fluid management in patients with severe pneumonia and heart failure (HF) and the risk factors for 28-day mortality.Methods:We retrospectively analyzed the data from 121 patients with severe pneumonia and HF in Peking University Shougang Hospital from January 2013 to January 2015.Fifty-seven patients who received PiCCO-guided fluid management served as PiCCO group,and 64 patients who received central venous pressure-guided fluid management as the control group.Results:The fluid intake during the first 12 h in PiCCO group was significantly more than that in the control group (P ＜ 0.05).However,within 24-48 and 48-72 h,fluid intake volume was similar between two groups (P ＞ 0.05).Additionally,APACHE Ⅱ and SOFA scores in the PiCCO group were significantly lower than those in the control group (P ＜ 0.05).Logistic regression analysis demonstrated that age,SOFA,APACHE Ⅱ scores and ventilation duration were independent risk factors for 28-day mortality.ROC curve showed that age ≥67 years old,SOFA ≥6,APACHE Ⅱ[≥23 and ventilation duration ≥7 days were the thresholds.Conclusion:PiCCO could accurately guide fluid management in patients with severe pneumonia and HF,with shorter duration of mechanical ventilation and ICU stay days,though 28-day mortality was similar between two groups.Age,APACHE Ⅱ score,SOFA score and ventilation duration were independent risk factors for 28-day mortality.%目的:探讨脉搏指示连续心搏出量检测(PiCCO)技术指导液体管理对重症肺炎合并心力衰竭预后的影响.方法:选择重症肺炎合并心力衰竭患者121例,应用PiCCO技术指导液体管理的57例患者作为PiCCO组,同期选择基础情况类似的应用中心静脉压指导液体管理的64例患者作为对照组,比较2组临床资料和预后情况.结果:PiCCO组患者的0～12h液体出量明显多于对照组(P＜0.05),但24～48 h、48 ～72 h2组无显著差别(P＞0.05).治疗3d时,PiCCO组患者的APACHEⅡ、SOFA评分均较对照组显著降低,但CPIS评分2组无明显差异.住院期间PiCCO组应用血管活性药物的比例、血液净化率、机械通气时间等较对照组均显著减少(均P＜0.05),但2组住院期间和28 d生存均无显著差别(P＞0.05).Logistic回归分析显示年龄(P=0.003)、APACHEⅡ评分(P=0.01)、SOFA评分(P =0.02)和机械通气时间(P=0.002)为28 d病死率的独立危险因素,年龄≥67岁、SOFA≥6分、APACHEⅡ≥23分和机械通气时间≥7 d为相应危险因素的阈值.结论:PiCCO技术可以精确指导重症肺炎合并心力衰竭患者液体管理,减少机械通气时间和ICU住院时间,但对短期病死率无明显影响.年龄、APACHEⅡ评分、SOFA评分和机械通气时间为28 d病死率的独立危险因素.