Pan Guojun, Fan Xiuli, Bian Jie, He Zemin, Yue Jiajun, Sun Hua, Zou Fei, Chao Chenglei, Chao Yiqun, Fu Ying, Wang Xiao, Chen Shuhua
Department of Critical Care Medicine, Changzhou Fourth People's Hospital Changzhou 213000, Jiangsu Province, China.
Department of Emergency, Changzhou Fourth People's Hospital Changzhou 213000, Jiangsu Province, China.
Am J Transl Res. 2021 Jun 15;13(6):6846-6854. eCollection 2021.
This study was designed to demonstrate the predictive value of Pulse indicate Contour Cardiac Output (PiCCO) monitoring technique combined with troponin I (cTnI) detection in septic myocardial dysfunction (SMD) of the elderly.
One hundred and nineteen elderly patients with SMD treated in our hospital from March 2016 to September 2019 were enrolled and allocated into the joint group (JG; 64 cases) for capacity management of fluid resuscitation under the guidance of PiCCO monitoring technique and cTnI detection, and the control group (CG; 55 cases) for conventional capacity management. Clinical indicators, hemodynamics, improvement of myocardial injury markers and inflammatory factors 6 h and 36 h post intervention, fluid balance 6 h, 12 h and 36 h post intervention, drug consumption (norepinephrine), treatment effect and 28-day hospitalization mortality were compared between the two groups.
After resuscitation, the urine volume per hour and the fluid resuscitation volume were higher while the blood lactic acid (BLA) expression was lower in JG as compared to CG. JG presented a remarkably lower central venous pressure (CVP) than CG after resuscitation, with notably higher mean arterial pressure (MAP) and central venous oxygen saturation (ScvO2). In comparison with CG, JG displayed dramatically lower cTnI and N-terminal pro-brain natriuretic peptide (NT-ProBNP) 6 h and 36 h post intervention, as well as evidently reduced interleukin-6 (IL-6), procalcitonin (PCT) and high-sensitivity C-reactive protein (hs-CRP). After 36 h of intervention, the fluid balance was evidently lower in JG than in CG. JG showed statistically less use of norepinephrine, less time of mechanical ventilation and ICU stay, and noticeably lower incidence of multiple organ dysfunction syndrome (MODS), as well as dramatically lower 28-day hospitalization mortality than CG post intervention.
PiCCO monitoring technique combined with cTnI detection is high-performing in fluid resuscitation of elderly patients with SMD, which can meliorate the myocardial function of patients, reduce medication and facilitate disease recovery.
本研究旨在探讨脉搏指示连续心输出量（PiCCO）监测技术联合肌钙蛋白I（cTnI）检测对老年脓毒症性心肌功能障碍（SMD）的预测价值。
选取2016年3月至2019年9月在我院治疗的119例老年SMD患者，分为联合组（JG，64例），采用PiCCO监测技术联合cTnI检测指导液体复苏容量管理；对照组（CG，55例）采用传统容量管理。比较两组干预后6 h和36 h的临床指标、血流动力学、心肌损伤标志物及炎症因子改善情况，干预后6 h、12 h和36 h的液体平衡情况，药物用量（去甲肾上腺素）、治疗效果及28天住院死亡率。
复苏后，JG每小时尿量和液体复苏量高于CG，血乳酸（BLA）表达低于CG。复苏后JG中心静脉压（CVP）显著低于CG，平均动脉压（MAP）和中心静脉血氧饱和度（ScvO2）显著高于CG。与CG相比，JG干预后6 h和36 h的cTnI和N末端脑钠肽前体（NT-ProBNP）显著降低，白细胞介素-6（IL-6）、降钙素原（PCT）和高敏C反应蛋白（hs-CRP）明显降低。干预36 h后，JG的液体平衡明显低于CG。JG干预后去甲肾上腺素用量少且机械通气和ICU住院时间短，多器官功能障碍综合征（MODS）发生率显著降低，28天住院死亡率显著低于CG。
PiCCO监测技术联合cTnI检测在老年SMD患者液体复苏中效果显著，可改善患者心肌功能，减少用药，促进疾病康复。
