張秀麗 郭亮 林樂清

[摘要] 目的 研究脈波指示劑連續(xù)心排血量監(jiān)測(cè)聯(lián)合重癥超聲在膿毒性休克伴心功能不全患者中的應(yīng)用。 方法 選取2016年1月至2020年6月收入杭州師范大學(xué)附屬醫(yī)院重癥監(jiān)護(hù)室的膿毒性休克伴心功能不全的40名患者，隨機(jī)分為兩組，觀察組采用脈波指示劑連續(xù)心排血量監(jiān)測(cè)聯(lián)合重癥超聲（20例），對(duì)照組采用脈波指示劑連續(xù)心排血量監(jiān)測(cè)（20例）。觀察達(dá)到復(fù)蘇目標(biāo)液體總量、去甲腎上腺素劑量、血管外肺水、全心舒張末期容量、外周灌注指數(shù)、心率、CRRT使用率及28 d病死率。 結(jié)果 觀察組復(fù)蘇液體量（1.13±0.27）L及去甲腎上腺素劑量（4.28±1.20）μg/（kg·min），對(duì)照組復(fù)蘇液體量（1.52±0.42） L及去甲腎上腺劑量（5.82±1.10）μg/（kg·min），較對(duì)照組低;觀察組血管外肺水（4.70±0.85）mL/kg較對(duì)照組（5.32±0.72）mL/kg少，觀察組全心舒張末期容量（636.92±61.34）mL/m2較對(duì)照組（735.09±56.05）mL/m2低、觀察組PI（2.98±0.58）較對(duì)照組（2.44±0.39）增加，觀察組（87.00±13.60）次/min心率較對(duì)照組（101.10±10.03）次/min下降，差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）;觀察組（10%）對(duì)照組（20%）相比，CRRT使用無差異（P>0.05），觀察組28 d病死率（5%）和對(duì)照組（15%）比較無差異（P>0.05）。 結(jié)論 觀察組可減少液體量及去甲腎上腺劑量，全心舒張末期容量低，肺水減少，組織灌注更佳，較少引起心動(dòng)過速，不降低CRRT使用率及28 d病死率。

[關(guān)鍵詞] 脈波指示劑連續(xù)心排血量監(jiān)測(cè);重癥超聲;膿毒性休克;心功能不全

[中圖分類號(hào)] R459.7? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] B? ? ? ? ? [文章編號(hào)] 1673-9701（2021）24-0114-03

Application of PICCO combined with severe ultrasound in patients with septic shock and cardiac insufficiency

ZHANG Xiuli? ?GUO Liang? ?LIN Leqing

Intensive Care Unit， Affiliated Hospital of Hangzhou Normal University， Hangzhou? ?310015，? China

[Abstract] Objective To study the application of pulse wave indicator continuous cardiac output monitoring combined with critical ultrasound in patients with septic shock and cardiac insufficiency. Methods A total of 40 patients with septic shock and cardiac insufficiency who were admitted to the Intensive Care Unit in the Affiliated Hospital of Hangzhou Normal University from January to February 2016 were randomly divided into two groups. The observation group used pulse wave indicator continuous cardiac output monitoring combined with critical ultrasound （20 cases）. The control group used the pulse wave indicator to monitor continuous cardiac output （20 cases）. The total fluid volume reaching the resuscitation target， norepinephrine dose， extravascular lung water， global end-diastolic volume， peripheral perfusion index， heart rate， CRRT usage rate， and 28-day case fatality rate were observed. Results The resuscitation fluid volume （1.13±0.27） L and norepinephrine dose （4.28±1.20） μg/（kg·min） in the observation group was lower than the resuscitation fluid volume （1.52±0.42） L and norepinephrine dose （5.82±1.10） μg/（kg·min） in the control group. The extravascular lung water （4.70±0.85） mL/kg in the observation group was less than （5.32±0.72） mL/kg in the control group. The observation group′s global end-diastolic volume （636.92±61.34） mL/m2 was lower than （735.09±56.05） mL/m2 of the control group. The PI of the observation group （2.98±0.58） was higher than （2.44±0.39） of the control group. The heart rate of the observation group （87.00±13.60） once/min was lower than that of the control group （101.10±10.03） once/min， and the difference was statistically significant （P>0.05）. There was no difference in the use of CRRT between the observation group （10%） and the control group （20%） （P>0.05）. There was no difference between the observation group （5%） and the control group （15%） in the 28 d case fatality rate（P>0.05）. Conclusion The observation group can reduce fluid volume and dose of norepinephrine， which has low end-diastolic volume， reduced lung water， better tissue perfusion and less tachycardia， and does not reduce CRRT usage and 28-day mortality.