【摘要】 目的 探讨脉搏波形指示连续心排血量（Pi CCO）在重症腹部外科患者容量管理中的临床应用价值。方法 选取 60 例重症腹部外科患者作为研究对象，采用随机数字表法将其分为研究组和对照组，每组 30 例。所有患者均采用对症治疗，对照组采用常规监测方式对补液进行指导，研究组采取 Pi CCO 监测对补液进行指导。比较 2 组的补液总量、尿量、机械通气时间、病死率、住院时间，比较 2 组治疗前（T₀）、治疗 12 h（T₁）、治疗 24 h（T₂）的心率、平均动脉压（MAP）、氧合指数（OI）、中心静脉血氧饱和度（Scv O₂）、血乳酸、急性生理学与慢性健康状况系统Ⅱ（APACHE Ⅱ）评分，并比较 2 组治疗期间不良事件的发生情况。结果 研究组补液总量、住院时间、病死率均低于对照组（P 均< 0.05）。2 组心率、OI 水平组内比较 T₀>T₁>T₂,MAP 组内比较 T₀<T₁<T₂（P 均< 0.05）。2 组血乳酸水平及 APACHE Ⅱ评分组内比较 T₀>T₁>T₂,Scv O₂水平组内比较 T₀<T₁<T₂（P 均< 0.05）；研究组 T₁、T₂时血乳酸水平及APACHE Ⅱ评分均低于对照组，Scv O₂水平高于对照组（P 均<0.05）。研究组在治疗期间不良事件总发生率为 10%，低于对照组的 33%（P < 0.05）。结论 Pi CCO 监测可更好地指导重症腹部外科患者进行容量管理，改善患者预后，临床价值较高。更多还原

【Abstract】 Objective To investigate the clinical application value of pulse indicated continuous cardiac output（PiCCO） in volume management of patients undergoing severe abdominal surgery. Methods Sixty patients undergoing severe abdominal surgery were recruited and divided into the study group（n = 30） and control group（n = 30） by random number table method. All patients received symptomatic treatment. Patients in the control group received routine monitoring to guide fluid infusion, and their counterparts in the study group were given with PiCCO monitoring to guide fluid infusion. The total volume of infusion, urine volume, duration of mechanical ventilation, mortality rate and length of hospital stay were compared between two groups. Heart rate（HR）, mean arterial pressure（MAP）, oxygenation index（OI）, central venous oxygen saturation（ScvO₂）, lactic acid（LAC）, Acute Physiology and Chronic Health Evaluation Ⅱ（APACHE Ⅱ） before treatment（T0）, after 12 h（T₁） and 24 h treatment（T₂） were compared between two groups. The incidence of adverse events was also compared between two groups. Results The total volume of infusion, length of hospital stay and mortality rate in the study group were significantly lower than those in the control group（all P < 0.05）. In each group, the orders of HR and OI were T₀ > T₁ > T₂, that of MAP was T₀ < T₁ < T₂（all P < 0.05）. The orders of LAC level and APACHE Ⅱ score were T₀ > T₁ > T₂, and that of ScvO₂ level was T₀ < T₁ < T₂（all P < 0.05）, respectively. In the study group, LAC level and APACHE Ⅱ score at T₁ and T₂ were significantly lower, whereas ScvO2 at T₁ and T₂ was significantly higher than those in the control group（all P < 0.05）. The total incidence of adverse events in the study group was 10%, significantly lower than 33% in the control group（P < 0.05）. Conclusion PiCCO monitoring can better guide the volume management of patients undergoing severe abdominal surgery, improve clinical prognosis and yield high clinical value.更多还原