摘要
目的探讨脉搏指示连续心排出量（PiCCO）监测在心脏骤停后综合征（PCAS）患者早期血流动力学优化中的应用价值。方法将44例PCAS患者随机分成两组：常规组2l例，早期血流动力学优化目标为中心静脉压8～12mmHg，平均动脉压65～90mmHg，ScvO2≥70％，HCT≥30％；PiCCO组23例，根据全心舒张末期容积指数（GEDI）进行液体复苏，使GEDI达到650～800mL／m2；并根据外周血管阻力指数（SVRI）调节去甲肾上腺素剂量，使SVRI达到1200—2000dyn·s／（cm5·m2）。统计前3d的液体输入量、去甲肾上腺素用量，比较两组的病死率。结果PiCCO组3d病死率低于常规组（26．1％V876．2％，P〈0．05），7d和28d比较差异无统计学意义（P均〉0．05）。PiCCO组前3d的液体输入量少于常规组（P均〈0．05）。PiCCO组第1天的去甲。肾上腺素用量多于常规组（P〈0．05），但第2、3天差异无统计学意义（P均〉0．05）。结论在PCAS患者早期血流动力学优化中采用PiCCO监测，能更好地进行液体管理和合理的使用血管活性药物，有利于改善预后。
Objective To evaluate the value of cardiopulmonary capacity monitor PiCCO in the early hemodynamic optimization of patients with post - cardiac arrest syndrome （PCAS）. Methods 44 patients with PCAS were divided into two groups randomly. A total of 21 patients with PCAS were treated as the conventional treatment group; and another 23 patients were treated under the guidance of PiCCO as PiCCO group. The goals of early hemodynamic optimization have included a central venous pressure of 8 to 12 mm Hg, the mean arterial blood pressure of 65 to 90 mm Hg, ScvO2≥70% , hematoerit≥30% in the conventional treatment group. In PiCCO group, the fluid resuscitation was concluded when global end - diastolic volume index reached 650 - 800 mL/m2 ; Nor - epinephrine was administrated to adjust the systemic peripheral vascular resistance index during 1200 - 2000 dyn s/（ cm5 m2）. The fluid intake for 3 days and the dosage of nor - epinephrine were recorded. The rate of mortality was compared between two groups. Results The 3 - day mortality rate of PiCCO group was lower than that of the conventional treatment group （26.1% vs 76.2%, P 〈 0.05 ）. There were no significant difference in 7, 28 -day mortality rate between two groups（43.4% vs 81.0% ,56.5% vs g5.7% , all P 〉 O. 05）. The fluid intake of PiCCO group were less than those of the conventional treatment group [ （3532 ± 535 ）mL vs （4397 ±641）mL, （2672±413）mL vs （3218 ±463）mL, （1962 ±334）mL vs （2516 ±351）mL, all P 〈 0.05 ]. The dosage of nor - epinephrine of PiCCO group in ld was higher than that of the conventional treatment group [ （53.8 ± 8.1 ）mg vs （41.9 ± 7.5 ）mg, P 〈 0.05]. However, the dosage of nor - epinephrine were similar between two groups in 2, 3 d [ （22.5 ± 6. 1 ） mg vs （20.8 ±5.3 ） rag, （6. 7 ± 1.6 ） mg vs （ 6.2± 1.4 ） mg, all P 〉 0.05 ]. Conclusion When the early hemodynamic optimization guided with PiCCO in PCAS patients, the fluid management and the usage of vasopressors can be implement more safely and precisely. It could improve the prognosis of PCAS patients.
出处
《中国急救医学》
CAS
CSCD
北大核心
2012年第10期881-884,共4页
Chinese Journal of Critical Care Medicine
