【摘要】 目的 研究脉搏轮廓温度稀释连续心排血量测量技术（PICCO）救治严重脓毒症和脓毒性休克患者的临床应用疗效。方法 选取2015年6月至2017年9月本院重症医学科住院的严重脓毒症和脓毒性休克患者44例,随机分成两组,观察组20例,对照组24例,对照组按照传统方法救治,以中心静脉压（CVP）的变化指导液体复苏;观察组除按照传统方法救治外,根据PICCO血流动力/容量管理决策树指导液体复苏,比较两组患者液体复苏治疗的疗效与转归,了解PICCO指导液体复苏时患者血流动力学参数的变化。结果 ①两组患者治疗24 h和72 h后的CVP、MAP、乳酸（Lac）、氧合指数（PaO₂/FiO₂）、BNP比较,两组比较差异具有统计学意义（P <0. 05）;②两组患者治疗72h后的ScvO₂、尿量（UO）、血管活性药物平均评分比较,两组比较差异具有统计学意义（P <0. 05）;③两组有创机械通气时间、ICU住院天数与28天病死率比较,差异有统计学意义（P <0. 05）。结论 与CVP监测比较,PICCO指导严重脓毒症和脓毒性休克患者液体复苏更加有利,可以安全、准确、有效指导严重脓毒症和脓毒症休克病人容量管理。更多还原

【Abstract】 Objective Discussion in application study on PICCO monitoring technology in guidance of clinical treatment in patients with severe sepsis and septic shock in our hospital. Methods Select from June 2015 to September 2017 admitted to our hospital ICU of 44 patients with severe sepsis and septic shock,were randomly divided into two groups,20 cases in the observation group,according PICCO hemodynamic/capacity managemental decison tree to guide fluid resuscitation of patients; 24 cases in the control group,CVP as a guide to fluid resuscitation indicators. Fluid resuscitation of patients were compared with the outcomes of treatment efficacy,understand the changes under the guidance of fluid resuscitation of patients according PICCO monitor hemodynamic parameters. Results ① Compared CVP、 MAP、 Lac、Pa O2/Fi O2、BNP between the two groups after treating 24 h and 72 h,the difference was statistically significant( P < 0. 05). ② Compared Scv O2、UO and vascular active pharmaceutical grade between the two groups after treating 72 h,the difference was statistically significant( P < 0. 05). ③ Compared the incidence rates of the time of invasive mechanical ventilation、the length of stay in ICU and 28-day mortality between the two groups,the difference was statistically significant( P < 0. 05). Conclusions PICCO monitoring technology in guidance fluid resuscitation is more beneficial than CVP monitoring to guide patients with severe sepsis and septic,and it can more safely,accurately and effectively guide capacity management in patients with severe sepsis and septic shock.更多还原