摘要
目的探讨脉搏指示连续心排血量(pulse index continuous cardiac output,PiCCO)监测在危重烧伤患者中的应用效果。方法对2018年5月至2019年5月河南大学附属南石医院收治的20例危重烧伤患者予以补液抗休克、抗感染、改善微循环、积极治疗原发病、营养支持等全身综合治疗以及负压封闭引流联合烧伤创疡再生医疗技术等局部创面治疗,治疗过程中采用PiCCO监测仪监测平均动脉压(mean arterial pressure,MAP)、外周血管阻力指数(systemic vascular resistance index,SVRI)、心功能指数(cardiac function index,CFI)、心脏指数(cardiac index,CI)、胸腔内血容量指数(intrathoracic blood volume index,ITBVI)、血管外肺水指数(extravascular lung water index,EVLWI)等血流动力学指标,观察各项指标变化情况。结果因患者血容量不足,烧伤后CFI、CI、ITBVI均显著降低,而SVRI则显著升高,随着治疗时间的延长,各项指标逐渐趋于正常,各时间点SVRI、CFI、CI、ITBVI组内对比,差异具有统计学意义(F=18.420、8.528、8.890、8.329,P均=0.000);烧伤后及治疗过程中MAP、EVLWI均未见明显变化,各时间点组内对比,差异无统计学意义(F=1.373、0.810,P=0.258、0.493);根据PiCCO监测结果,结合患者生命体征及时调整补液性质、补液量及补液速度,所有患者均顺利度过休克期。结论危重烧伤患者采用PiCCO监测,可安全、及时、准确、动态监测患者血流动力学指标,指导液体复苏,进而有效维持患者生命体征稳定,临床应用价值较高。
Objective To explore the effect of monitoring pulse index continuous cardiac output(PiCCO)in patients with severe burns.Methods Twenty patients with severe burns,admitted into Nanshi Hospital of Nanyang from May2018 to May 2019,were given comprehensive treatments,including fluid resuscitation to prevent shock,infection prevention,improvement of microcirculation,active treatment of primary diseases,nutritional support,and local wound treatments including vacuum sealing drainage combined with MEBT/MEBO.During the course of treatment,PiCCO monitor was used to monitor the hemodynamic indexes including mean arterial pressure(MAP),systemic vascular resistance index(SVRI),cardiac function index(CFI),cardiac index(CI),intrathoracic blood volume index(ITBVI)and extravascular lung water index(EVLWI)and the changes of these indexes were observed.Results Due to insufficient blood volume,CFI,CI and ITBVI of patients decreased significantly after burns,whereas their SVRI increased significantly.As the treatment progressed,these indexes gradually turned to normal.The SVRI,CFI,CI,ITBVI at each time point were compared within each group and the results showed statistically significant differences(F=18.420,8.528,8.890 and 8.329 respectively,all P=0.000),while before the treatment following the burn injury and during the course of treatment,no obvious changes were observed in MAP and EVLWI,the two indexes at each time point were compared within each group and no statistically significant differences were observed(F=1.373 and 0.810,P=0.258 and 0.493);based on the PiCCO monitoring results and the patient’s vital signs,the properties,speed and volume of fluid replacement were adjusted in time,and all patients got through the shock period.Conclusion PiCCO monitor,when applied in patients with severe burns,is safe and can timely display hemodynamic indexes accurately in real time to guide the procedures of fluid replacement,and further effectively help maintain the stability of the patient’s vital signs,presenting a high value of clinical application.
作者
邓岩岩
Deng Yanyan(Department of Burns,Nanshi Hospital of Nanyang,Nanyang City,Henan 473000,China)
出处
《中国烧伤创疡杂志》
2020年第4期258-261,共4页
The Chinese Journal of Burns Wounds & Surface Ulcers
关键词
脉搏指示连续心排血量监测
心肺容量监护仪
危重烧伤
休克
血流动力学
Pulse index continuous cardiac output monitoring
Cardiopulmonary volume monitor
Severe burns
Shock
Hemodynamics
