聂有和 魏美霞

【摘要】 目的：分析脉波指示剂连续性心排血量（pulse indicator continous cardiac output，PiCCO）监测在脓毒性休克早期液体复苏治疗中的应用对改善患者氧代谢异常的意义。方法：选取2018年5月-2020年5月本院收治的脓毒性休克患者72例，以双盲随机抽样法分为参照组和试验组，各36例。参照组采纳中心静脉压（CVP）指导液体复苏治疗，试验组采纳PiCCO指导液体复苏治疗。对比两组APACHEⅡ评分、每小时尿量、CVP、MAP、复苏液体量、乳酸清除率、并发症发生率、呼吸机使用率。结果：治疗24 h后，试验组APACHEⅡ评分比参照组低，每小时尿量、CVP、MAP、复苏液体量、乳酸清除率均比参照组高，并發症发生率、呼吸机使用率均比参照组低，差异均有统计学意义（P<0.05）。结论：PiCCO指导液体复苏治疗可有效改善脓毒性休克患者病情，增加尿量，提高乳酸清除率，降低并发症发生率及呼吸机使用率，值得借鉴。

【关键词】 脉波指示剂连续性心排血量 脓毒性休克 液体复苏 氧代谢异常

[Abstract] Objective： To analyze the significance of pulse indicator continous cardiac output （PiCCO） monitoring in early fluid resuscitation of septic shock in improving abnormal oxygen metabolism. Method： A total of 72 patients with septic shock admitted to our hospital from May 2018 to May 2020 were selected， they were divided into the reference group and the experimental group， by double-blind random sampling， 36 cases in each group. The reference group was guided by central venous pressure （CVP） for fluid resuscitation treatment， the experimental group adopted PiCCO to guide fluid resuscitation treatment. The APACHEⅡ score， hourly urine output， CVP， MAP， resuscitation fluid volume， lactic acid clearance rate， complication rate， and ventilator utilization rate were compared between two groups. Result： After 24 h of treatment， the APACHEⅡ score of the experimental group was lower than that of the reference group， the hourly urine volume， CVP， MAP， resuscitation fluid volume， lactic acid clearance rate were all higher than those of the reference group， the incidence of complications and ventilator utilization were all lower than those of the reference group， with statistically significant differences （P<0.05）. Conclusion： PiCCO guiding fluid resuscitation therapy can effectively improve the condition of septic shock patients， increase urine volume and increase lactic acid clearance rate， reduce the incidence of complications and ventilator utilization rate， worthy of reference.

[Key words] Pulse indicator continuous cardiac output Septic shock Fluid resuscitation Abnormal oxygen metabolism

First-authors address： Maoming Peoples Hospital， Maoming 525000， China

doi：10.3969/j.issn.1674-4985.2021.03.035

脓毒性休克是一种临床常见病，一般是由脓毒症引发，机体乳酸含量在4 mmol/L以上，组织灌注不充足[1]。目前，临床普遍认为该病是由于细胞毒素诱发免疫反应，白三烯、内毒素等物质均参与了疾病的发生、发展，在上述致病因素的影响下动脉扩张，周围动脉的阻力降低，心排出量增加，导致毛细血管的交换功能受损，二氧化碳清除减少、氧气供应不足，出现多器官衰竭、灌注不足等情况，进而引发休克症状[2-3]。早期液体复苏是目前临床治疗脓毒性休克的主要手段，但如果容量负荷较大，反而会加重原发病。脉波指示剂连续性心排血量（pulse indicator continous cardiac output，PiCCO）可以精确地反映出血管阻力以及心脏前后负荷，更加准确、客观地反映出容量状态，进而指导液体复苏，合理使用血管药物。……