基于肺动脉导管的方案对早期脓毒症患者液体及儿茶酚胺给药的影响
The impact of a pulmonary-artery-catheter-based protocol on fluid and catecholamine administration in early sepsis.
作者信息
Bethlehem Carina, Groenwold Frouwke M, Buter Hanneke, Kingma W Peter, Kuiper Michael A, de Lange Fellery, Elbers Paul, Groen Henk, van Roon Eric N, Boerma E Christiaan
机构信息
Department of Intensive Care, Medical Centre Leeuwarden, P.O. Box 888, 8901 BR Leeuwarden, The Netherlands.
出版信息
Crit Care Res Pract. 2012;2012:161879. doi: 10.1155/2012/161879. Epub 2012 Feb 21.
Objective. The pulmonary artery catheter (PAC) remains topic of debate. Despite abundant data, it is of note that many trials did not incorporate a treatment protocol. Methods. We retrospectively evaluated fluid balances and catecholamine doses in septic patients after the introduction of a PAC-based treatment protocol in comparison to historic controls. Results. 2 × 70 patients were included. The first day the PAC group had a significantly higher positive fluid balance in comparison to controls (6.1 ± 2.6 versus 3.8 ± 2.4 litre, P < 0.001). After 7 days the cumulative fluid balance in the PAC group was significantly lower than in controls (9.4 ± 7.4 versus 13 ± 7.6 litre, P = 0.001). Maximum dose of norepinephrine was significantly higher in the PAC group. Compared to controls this was associated with a significant reduction in ventilator and ICU days. Conclusions. Introduction of a PAC-based treatment protocol in sepsis changed the administration of fluid and vasopressors significantly.
目的。肺动脉导管（PAC）仍是一个有争议的话题。尽管有大量数据，但值得注意的是，许多试验并未纳入治疗方案。方法。我们回顾性评估了在引入基于PAC的治疗方案后脓毒症患者的液体平衡和儿茶酚胺剂量，并与历史对照进行比较。结果。纳入了2组，每组70例患者。在使用PAC的第一天，与对照组相比，该组患者的液体正平衡显著更高（6.1±2.6升对3.8±2.4升，P<0.001）。7天后，PAC组的累积液体平衡显著低于对照组（9.4±7.4升对13±7.6升，P = 0.001）。PAC组去甲肾上腺素的最大剂量显著更高。与对照组相比，这与呼吸机使用天数和重症监护病房（ICU）住院天数的显著减少相关。结论。在脓毒症中引入基于PAC的治疗方案显著改变了液体和血管加压药的使用。
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