【摘要】 目的观察脉搏指示性连续心排量监测(PiCCO)及心脏超声指导重型颅脑损伤合并心功能不全患者的容量管理,并探讨对临床预后的影响。方法纳入2015年3月至2016年8月本院重症监护室收治的重型颅脑损伤合并心脏功能不全的患者61例,随机分为观察组和对照组,观察组30例,对照组31例。观察组应用PiCCO及床旁心脏超声进行血流动力学监测,对照组根据中心静脉压(CVP)等常规指标进行血流动力学监测,两组疗程均为72h。对比两组患者72h时的液体平衡、肺超声B线评分、血浆脑利钠肽(BNP)及动脉全血乳酸水平;统计两组机械通气时间、ICU住院时间,肺部感染发生率、治疗2w格拉斯哥昏迷评分(GCS)及28d病死率。结果治疗72h时,观察组液体正平衡、肺超声B线评分、BNP、乳酸水平优于对照组(P均<0.05);两组除28d病死率外,机械通气时间、ICU住院时间、肺部感染发生率、治疗2w GCS评分,观察组均优于对照组,差异有统计学意义(均P<0.05)。结论 PiCCO与心脏超声可以优化重型颅脑损伤合并心功能不全患者患者的容量管理,减少机械通气时间及ICU住院时间,降低肺部感染发生率,提高2w GSC评分分值。更多还原

【Abstract】 Objective To observe the applying PiCCO and cardiac ultrasound to gudie the volume management in patients with severe brain injury complicated by cardiac dysfunction, to investigate the effects on clinical prognosis. Method sixty-one patients with severe brain injury complicated by cardiac dysfunction treated in the ICU of our hospital between March 2015 and August 2016 were included, and divided into observation group and control group, with 30 patients in observation group and 31 patients in control group, by using a randomized method. Hemodynamic management was carried out in the experimental group by PiCCO combined with bedside cardiac ultrasound; while hemodynamic management in the control group was based on routine indexes of CVP and other monitors. The course of treatment in both group is 72 h, and fluid balance, B-line score with lung ultrasound, the plasma BNP and whole blood lactate was compared between the two groups at 72 h. We also summarized the dates and indicators in the two groups which included duration of mechanical ventilation, length of stay in ICU, the incidence of pneumonia, Glasgow coma scale(GCS) at 2 weeks and 28-day mortality. Results As compared with the control group at 72 h, the fluid balance, B-line score with lung ultrasound, the plasma BNP and whole blood lactate in observation group was was superior over control group(all P<0.05); with the exception of 28-d mortality,length of stay in ICU, duration of mechanical ventilation, the incidence of pneumonia, GCS at 2 weeks in the observation group was superior over the control group, with statistically significant differences(all P<0.05). Conclusion PiCCO and cardiac ultrasound can optimize the volume management, shorten length of stay in ICU and duration of mechanical ventilationt, reduce the incidence of pneumonia, increase GCS at 2 weeks after admission in patients with severe brain injury complicated by cardiac insufficiency.更多还原