【摘要】 目的 探讨经胸超声心动图(TTE)和脉搏指示连续心排血量技术(PiCCO)指导脓毒性休克患者血流动力学监测及容量管理的价值。方法 选取40例脓毒性休克患者为研究对象,按照随机数字表法将患者分为TTE组和PiCCO组,每组20例。两组均给予常规治疗, TTE组应用TTE指导容量管理, PiCCO组应用PiCCO指导容量管理。比较两组治疗后6 h乳酸值、中心静脉压、平均动脉压、氧合指数、补液量、尿量及28 d死亡率、机械通气时间、重症监护室(ICU)入住时间。结果 TTE组治疗后6 h补液量为(1270.00±156.78)ml,少于PiCCO组的(1455.00±185.60)ml,差异有统计学意义(P<0.05);TTE组治疗后6 h乳酸值为(4.57±1.45)mmol/L、氧合指数为(289.60±34.81)mm Hg(1 mm Hg=0.133 kPa)、平均动脉压为(74.30±8.42)mm Hg、中心静脉压为(10.45±1.79)mm Hg及尿量为(190.00±37.28)ml,与PiCCO组的(4.42±1.12)mmol/L、(290.30±43.62)mm Hg、(72.90±6.21)mm Hg、(10.60±1.64)mm Hg、(198.00±44.32)ml比较,差异无统计学意义(P>0.05)。TTE组机械通气时间为(155.50±61.11)h、ICU入住时间为(9.00±2.38)d,均短于PiCCO组的(207.40±80.71)h、(10.95±3.00)d,差异有统计学意义(P<0.05)；两组28 d死亡率比较,差异无统计学意义(P>0.05)。结论 与PiCCO相比, TTE在脓毒性休克患者血流动力学监测及容量管理方面效果较好,值得临床推广使用。更多还原

【Abstract】 Objective To investigate the value of transthoracic echocardiography(TTE) and pulse indicator continuous cardiac output(PiCCO) for hemodynamic monitoring and volume management in patients with septic shock. Methods A total of 40 patients with septic shock were studied, and the patients were divided into TTE group and PiCCO group according to the random numerical table, with 20 patients in each group. Both groups received conventional treatment. The TTE group applied TTE-guided volume management, and the PiCCO group applied PiCCO-guided volume management. Both groups were compared in terms of lactate value,central venous pressure, mean arterial pressure, oxygenation index at 6 h after treatment, total fluid intake and urine volume, urine volume, 28-d mortality rate, duration of mechanical ventilation, and intensive care unit(ICU)residence time. Results The total fluid intake at 6 h after treatment in the TTE group was(1270.00±156.78) ml,which was less than(1455.00±185.60) ml in the PiCCO group, and the difference was statistically significant(P<0.05). TTE group had lactate value of(4.57±1.45) mmol/L, oxygenation index of(289.60±34.81) mm Hg(1 mm Hg=0.133 kPa), mean arterial pressure of(74.30±8.42) mm Hg, central venous pressure of(10.45±1.79) mm Hg and urine volume of(190.00±37.28) ml at 6 h after treatment, and the differences were not statistically significant(P>0.05) compared with(4.42±1.12) mmol/L,(290.30±43.62) mm Hg,(72.90±6.21) mm Hg,(10.60±1.64) mm Hg, and(198.00±44.32) ml in the PiCCO group. The duration of mechanical ventilation in the TTE group was(155.50±61.11) h and the ICU residence time was(9.00±2.38) d, which were shorter than(207.40±80.71) h and(10.95±3.00) d in the PiCCO group, and the differences were statistically significant(P<0.05). The difference was not statistically significant when comparing the 28-d mortality rate between the two groups(P>0.05). Conclusion Compared with PiCCO, TTE is more effective in hemodynamic monitoring and volume management in patients with septic shock, and is worthy of clinical promotion and application.更多还原