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目的探析脉波轮廓温度稀释连续心排血量监测技术(PiCCO)在脓毒性休克早期目标导向治疗(EGDT)中的应用价值。方法 48例脓毒性休克患者,按照随机数字表法分为参照组和治疗组,各24例。参照组依据中心静脉压(CVP)进行EGDT,治疗组在Pi CCO技术指导下进行EGDT,比较两组患者CVP、平均动脉压(MAP)、中心静脉血氧饱和度(ScvO_2)、氧合指数(PaO_2/FiO_2)、尿量以及1个月内多脏器功能障碍综合征(MODS)发生率、病死率。结果治疗组CVP为(10.5±1.2)mmHg(1 mmHg=0.133 kPa)、MAP为(76.7±11.7)mmHg、ScvO_2为(78.2±9.4)%、PaO_2/FiO_2为(378.3±50.2)%、尿量为(0.48±0.12)ml/(kg·h),均高于参照组的(6.4±1.2)mmHg、(60.7±13.7)mmHg、(57.5±8.0)%、(336.6±54.5)%、(0.34±0.12)ml/(kg·h),差异具有统计学意义(t=11.8357、4.3508、8.2156、2.7570、4.0414,P<0.05)。治疗组1个月内MODS发生率及病死率分别为20.8%(5/24)、12.5%(3/24),均明显低于参照组的50.0%(12/24)、41.7%(10/24),差异具有统计学意义(χ~2=4.4630、5.1692,P<0.05)。结论 Pi CCO技术指导下进行EGDT可显著提高脓毒性休克患者的临床疗效,进一步改善预后,具有积极的临床使用和推广意义。
Objective To investigate the value of pulse contoured temperature-controlled continuous cardiac output monitoring (PiCCO) in early target-directed therapy (EGDT) of septic shock. Methods Forty-eight patients with septic shock were divided into the reference group and the treatment group according to the random number table method, 24 cases in each. The reference group was given EGDT according to the central venous pressure (CVP). The patients in the treatment group were given EGDT under the guidance of Pi CCO technique. The CVP, MAP, ScvO_2, PaO_2 / FiO_2), urine output and the incidence of multiple organ dysfunction syndrome (MODS) and mortality in 1 month. Results The CVP in the treatment group was (10.5 ± 1.2) mmHg (1 mmHg = 0.133 kPa), MAP was (76.7 ± 11.7) mmHg, ScvO_2 was (78.2 ± 9.4)%, PaO_2 / FiO_2 was (378.3 ± 50.2)%, Were (0.48 ± 0.12) ml / (kg · h), higher than that of the control group (6.4 ± 1.2 mmHg, 60.7 ± 13.7 mmHg, 57.5 ± 8.0%, 336.6 ± 54.5%, 0.34 ± 0.12) ml / (kg · h), the difference was statistically significant (t = 11.8357,4.3508,8.2156,2.7570,4.0414, P <0.05). The morbidity and mortality of MODS within one month in treatment group were 20.8% (5/24) and 12.5% (3/24), respectively, which were significantly lower than those in the reference group (50.0%, 12/24, 41.7% 24), the difference was statistically significant (χ ~ 2 = 4.4630,5.1692, P <0.05). Conclusions The treatment of EGDT under the guidance of Pi CCO technique can significantly improve the clinical efficacy of patients with septic shock and further improve the prognosis, which has positive clinical use and promotion significance.