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目的:了解脉波轮廓温度稀释连续心排血量(PICCO)在危重患者连续性血液净化(CBP)中的应用效果。方法:选择行CBP治疗的危重患者30例,随机分为实验组和对照组,实验组根据PICCO技术所监测的数值包括平均动脉压(MAP)、胸腔内血容量(ITBV)、血管外肺水(EVLW)、全心舒张末期容积指数(GEDVI)设置超滤率,对照组根据常规的心率(HR)、MAP、中心静脉压(CVP)值设置超滤率,观察两组患者进行CBP治疗后24h、48 h、72 h、96 h的超滤率和去甲肾上腺素单位剂量,以及CBP治疗时间、治疗后APACHEⅡ评分。结果 :实验组的超滤率、血管活性药物的剂量及使用时间、CBP治疗时间、治疗后APACHEⅡ评分与对照组比较有显著性差异(P<0.05)。结论:PICCO容量监测能准确评估患者的血容量状态;在CBP过程中,根据患者临床症状和体征结合PICCO容量监测有助于确定合适的超滤率,从而实现个体化的液体管理。
Objective: To understand the effect of pulse contour temperature-controlled continuous cardiac output (PICCO) in continuous blood purification (CBP) in critically ill patients. Methods: 30 critically ill patients undergoing CBP were randomly divided into experimental group and control group. The experimental group according to the PICCO technique included MAP, ITBV, The EVLW and GEDVI were used to set the ultrafiltration rate. The control group was given routine treatment of heart rate (HR), MAP and central venous pressure (CVP) to set the ultrafiltration rate. After two groups of patients were treated with CBP 24h, 48h, 72h, 96h ultrafiltration rate and norepinephrine unit dose, and CBP treatment time, APACHE Ⅱ score after treatment. Results: The ultrafiltration rate of the experimental group, the dose and duration of vasoactive drugs, CBP treatment time, APACHE Ⅱ score after treatment were significantly different from the control group (P <0.05). CONCLUSIONS: PICCO volumetric monitoring accurately measures the patient’s blood volume status. During CBP, PICCO volume monitoring based on clinical symptoms and signs helps to determine the appropriate rate of ultrafiltration to achieve individualized fluid management.