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脉波指示剂连续心排血量监测技术(PiCCO)治疗心肌损伤合并感染性休克的疗效及预后分析。

Therapeutic Effect and Prognosis of PiCCO in the Treatment of Myocardial Injury Complicated with Septic Shock.

机构信息

Emergency Intensive Care Unit, Lianyungang Clinical College of Nanjing Medical University, The First People's Hospital of Lianyungang, Jiangsu, China.

Intensive Care Unit, The First People's Hospital of Lianyungang, Jiangsu, China.

出版信息

Comput Math Methods Med. 2022 Jun 6;2022:2910849. doi: 10.1155/2022/2910849. eCollection 2022.

Abstract

OBJECTIVE

To explore the effect of pulse-induced contour cardiac output (PiCCO) monitoring on the survival and prognosis of patients with myocardial injury and septic shock.

METHODS

A total of 400 patients with MI and septic shock who were treated in our hospital from May 2018 to June 2021 were included in the study. They were randomly grouped into the PiCCO group ( = 200) and the control group ( = 200) according to whether PiCCO was used for monitoring during the treatment period. The clinical baseline characteristics of all the patients were recorded. For comparison, we recorded hemodynamic parameters including mean arterial pressure (MAP), central venous pressure (CVP), heart rate (HR), troponin I (TnI), brain natriuretic peptide (BNP), oxygen metabolism parameters including systemic central venous oxygen saturation (ScvO), and lactate before and 6 h after intervention. In addition, white blood cell count (WBC) and C-reactive protein (CPR) levels before and 6 h, 24 h, 48 h, and 72 h after intervention were measured in both groups. Finally, the survival and prognostic parameters were compared between the two groups.

RESULTS

At 6 h after monitoring intervention, the hemodynamic parameters of the patients in the PiCCO group were significantly increased. Additionally, compared with the control group, the ScvO level was higher while the lactate level was lower in the PiCCO group. An intergroup comparison on inflammation also showed that WBC and CPR levels recovered better in the PiCCO group than in the control group. Moreover, patients with PiCCO monitoring showed better performance in outcome measures such as mortality, duration of invasive mechanical ventilation, length of hospital stay, duration of ventilator use, acute physiology and chronic health scores, and postoperative complications.

CONCLUSION

With the monitoring and guidance of the PiCCO technique, the nursing outcomes, survival rate, and prognosis of patients with myocardial injury and septic shock can be improved.

摘要

目的

探讨脉搏指示连续心排血量(PiCCO)监测对心肌损伤合并感染性休克患者的生存及预后的影响。

方法

选取 2018 年 5 月至 2021 年 6 月我院收治的心肌损伤合并感染性休克患者 400 例,按治疗期间是否采用 PiCCO 监测分为 PiCCO 组(n=200)和对照组(n=200)。记录所有患者的临床基线特征,比较两组患者的平均动脉压(MAP)、中心静脉压(CVP)、心率(HR)、肌钙蛋白 I(TnI)、脑钠肽(BNP)等血流动力学参数,以及全身中心静脉血氧饱和度(ScvO)、乳酸等氧代谢参数,记录两组患者白细胞计数(WBC)和 C 反应蛋白(CPR)水平在干预前及干预后 6 h、24 h、48 h、72 h 的变化,比较两组患者的预后指标。

结果

PiCCO 组患者在监测干预后 6 h 的血流动力学参数明显增加,ScvO 水平高于对照组,乳酸水平低于对照组。炎症比较显示,PiCCO 组患者的 WBC 和 CPR 水平恢复情况优于对照组。此外,PiCCO 监测患者在死亡率、有创机械通气时间、住院时间、呼吸机使用时间、急性生理与慢性健康评分(APACHEⅡ评分)、术后并发症等预后指标方面表现更好。

结论

PiCCO 技术监测和指导可改善心肌损伤合并感染性休克患者的护理结局、生存率和预后。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ee08/9192277/3af6d6c93a5c/CMMM2022-2910849.001.jpg

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