脉搏指示连续心排血量监测技术在劳力性热射病患者中应用

摘要

目的：探讨脉搏指示连续心排血量监测技术( PiCCO )在劳力性热射病患者治疗中的应用价值。方法收集2012年1月至2016年8月因热射病入住急诊ICU的患者48例。研究组23例以PiCCO监测指标指导患者的液体复苏,对照组25例以中心静脉压( CVP)指导患者的液体复苏。比较两组患者入住ICU时间、机械通气时间、连续肾脏替代疗法( CRRT)时间、转归情况分布、急性生理与慢性健康评分( APACHEⅡ)评分及液体复苏开始8、24、72 h入液量、平均动脉压( MAP)、CVP、中心静脉血氧饱和度( ScVO2)、血氧分压/吸入气体氧含量( PaO2/FiO2)、动脉乳酸( Lac)等指标的差别。结果对照组入住ICU时间、机械通气时间、CRRT时间均明显高于研究组,差异有统计学意义(χ2=-3．022,P<0．05；χ2=-7．474,P<0．05；χ2=-3．500,P<0．05)。两组患者转归情况分布及APACHEⅡ评分差异无统计学意义(χ2=0．510,P>0．05；χ2=-0．853,P>0．05)。8 h液体复苏后,研究组入液量(3597±2413)ml少于对照组(4257±2241)ml(P<0．05)；研究组PaO2/FiO2(132．04±23．10)mmHg高于对照组(128．57±18．64)mmHg(P<0．05)；研究组Lac(6．98±4．25)mmol/L低于对照组(7．05±4．65)mmol/L(P<0．05)。其余指标两组间比较,差异均无统计学意义。结论与对照组比较,研究组液体管理更加精准,减少盲目补液,缩短机械通气、入住ICU、CRRT持续时间。%Objective To investigate the clinical value of the pulse-indicated continuous cardiac output( PiCCO) monitoring technique in guiding exertional heat radiation disease. Methods A retrospective study was performed on 48 patients with heat stroke from January 2012 to August 2016. The experimental group using PiCCO monitoring indicators to guide 23 pa-tients in fluid resuscitation,the control group using the central venous pressure( CVP) as guidance index of fluid resuscita-tion. The clinical index such as the ICU admission time,mechanical ventilation time,continuous renal replacement therapy ( CRRT) time,the outcome of distribution,APACHE Ⅱ score,liquid intake of resuscitation after 8 hours,24 hours and 72 hours,mean arterial pressure( MAP) ,CVP,central venous blood oxygen saturation( ScVO2 ) ,blood oxygen partial pressure/oxygen content in gas( PaO2/FiO2 ) ,arterial lactic acid( Lac) in the two groups were compared and analyzed. Results The ICU admission time,duration of mechanical ventilation and CRRT time in the control group were significantly higher than those in the experimental group. The differences had statistical significance(χ2 = -3. 022,P<0. 05;χ2 = -7. 474,P<0. 05;χ2 = -3. 500,P<0. 05). The distribution and APACHE Ⅱ score in the two groups had no statistical significance (χ2 =0. 510,P>0. 05;χ2 = -0. 853,P>0. 05). Fluid resuscitation after 8 hours,the liquid intake in the experimental group(3 597 ±2 413)ml was less than that in the control group(4 257 ±2 241)ml(P<0. 05);PaO2/FiO2 in the experi-mental group(132. 04 ± 23. 10)mmHg was more than that in the control group(128. 57 ± 18. 64)mmHg(P<0. 05). Lac in the experimental group(6.98 ±4.25)mmol/L was less than that in the control group(7.05 ±4.65)mmol/L(P<0.05). The rest of the indicators in the two groups,there were no statistically significant difference. Conclusion PiCCO monitoring technique is more accurate than the CVP in liquid management. It can reduce blindness rehydration,shorten the duration of mechanical ventilation,ICU admission time and CRRT time.