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目的研究脉搏指示连续心输出量(picco)监测在危重烧伤患者早期液体复苏中的应用。方法 84例危重烧伤患者,随机分为观察组与对照组,每组42例。观察组采用picco监测,对照组采用常规方法监测。比较两组液体复苏前后急性生理学与慢性健康状况系统Ⅱ(APACHEⅡ)评分、心率(HR)、平均动脉压(MAP)、中心静脉压(CVP),比较观察组复苏前后血管外肺水指数(EVLWI)、胸腔内血容量指数(ITBVI)、全心舒张末容积指数(GEDVI)的变化。结果复苏后观察组APACHEⅡ评分(18.48±5.59)分、HR(98.64±20.69)次/min低于对照组(22.48±5.38)分、(120.59±26.16)次/min(P<0.05),MAP(91.65±17.68)mm Hg(1 mm Hg=0.133 kPa)、CVP(10.49±2.64)mm Hg高于对照组(83.97±17.61)、(8.04±2.05)mm Hg(P<0.05);观察组复苏后EVLWI(5.24±0.94)ml/kg、ITBVI(738.64±125.68)ml/m~2、GEDVI(734.61±125.29)ml/m~2显著高于复苏前(4.31±1.34)ml/kg、(532.08±65.05)ml/m~2、(417.94±92.64)ml/m~2(P<0.05)。结论 picco监测技术在危重烧伤患者早期液体复苏中有重要的临床指导意义。
Objective To study the application of pulsatile continuous cardiac output monitoring (picco) in early liquid resuscitation in critically ill patients with burn. Methods 84 cases of critically ill burn patients were randomly divided into observation group and control group, with 42 cases in each group. Observation group using picco monitoring, control group using routine monitoring methods. Before and after resuscitation, APACHEⅡ, HR, MAP and CVP were compared between two groups before and after resuscitation. The extravascular lung water index (EVLWI) ), Intrathoracic blood volume index (ITBVI) and global end-diastolic volume index (GEDVI). Results After the resuscitation, the APACHEⅡscore of the observation group (18.48 ± 5.59), HR (98.64 ± 20.69) / min was lower than that of the control group (22.48 ± 5.38), (120.59 ± 26.16) times / min 91.65 ± 17.68) mmHg (10.49 ± 2.64) mmHg higher than that of the control group (83.97 ± 17.61) and (8.04 ± 2.05) mm Hg respectively (P <0.05) The levels of EVLWI (5.24 ± 0.94) ml / kg, ITBVI (738.64 ± 125.68) ml / m 2 and GEDVI (734.61 ± 125.29) ml / m 2 were significantly higher than those before the resuscitation (4.31 ± 1.34 ml / 65.05) ml / m ~ 2, (417.94 ± 92.64) ml / m ~ 2 (P <0.05). Conclusion The picco monitoring technique has important clinical significance in early liquid resuscitation in critically ill burn patients.