【摘要】 目的探讨不同液体管理方式对心衰合并休克患者治疗效果的影响。方法对2015年1月—2016年12月在南宁市第三人民医院ICU住院的49例心衰合并各类休克患者,按随机原则分入精确液体管理组(实验组)24例和常规液体管理组(对照组)25例。实验组采取脉搏指示连续心排血量(PiCCO)监测检测仪监测进行液体管理,实时指导及调整液体治疗方案。对照组根据临床症状、体征、尿量及中心静脉压等传统指标进行液体管理,制定及调整液体治疗方案。结果实验组24h液体复苏达标率、第3dB型钠尿肽下降幅度高于对照组,差异有统计学意义(P <0.01);治疗后第1d、第3d血乳酸水平的下降程度、1周脱机率高于对照组(P <0.05)。结论 PiCCO指导下精确液体管理能在实现早期液体复苏目标的同时促进心力衰竭合并休克患者心功能恢复,改善组织器官灌注,缩短呼吸机使用时间。更多还原

【Abstract】 Objective To investigate the treatment outcomes of different liquid management methods in the treatment of patients with heart failure combined with shock. Methods Fourty-nine cases of patients with heart failure combined with shock from ICU of the Third People’s Hospital of Nanning from January 2015 to December 2016 were randomly divided into accurate liquid management group(experimental group,n=24)and conventional liquid management group(control group,n=25).In the experimental group,pulse indicator continuous cardiac output(PiCCO)was used to monitor the liquid management,and the liquid treatment regimen was guided and adjusted in real time.In the control group,liquid management was conducted according to traditional indexes such as clinical symptoms,signs,urine volume and central venous pressure,so that liquid treatment regimen was formulated and adjusted. Results In the experimental group,the rate of standard-obtained for liquid resuscitation in 24 hours and the decrease rate of brain natriuretic peptide(BNP)on day 3 after treatment were significantly higher than those in the control group,and the differences were statistically significant(P <0.01).The rate of weaning from machine ventilation in a week and the decline of lactate acid on day1 and 3 after treatment in the experiment group were higher than those in the control group,which the differences were statistically significant(P <0.05). Conclusion Accurate fluid management guided by PiCCO can achieve the goal of early fluid resuscitation,at the same time,promote cardiac function recovery in patients with heart failure combined with shock.It can improve tissue and organ perfusion and shorten the time of ventilator use.更多还原