摘要
目的分析"五根管道"结合脉搏指示连续心排血量监测(pulse indicator continuous cardiac output,PICCO)技术在烧伤患者中的临床疗效及影响预后的相关因素.方法:选取2017年3月—2019年6月入西南医科大学附属医院烧伤科的131例患者,随机分为两组,观察组66例以及对照组65例.患者所采用的疗法相同,在护理过程中采用"五根管道"策略,其中对照组采用常规监测方法指导液体复苏,观察组合用PICCO技术.比较分析两组患者的血流动力学指标、液体复苏时间、并发症发生率、病死率以及其他指标恢复时间等.比较分析其相关预后因素,采用二分类非条件Logistic回归分析其独立的相关因素.结果:观察组患者的缺氧改善时间、复苏达标时间和ICU天数相比对照阻均明显所缩短(P<0.01);与对照组比较,观察组的建立静脉通道时间、早期有效救治时间无统计学差异(P>0.05),而液体复苏后的心指数(cardiac index,CI)、心排血量(cardiac output,CO)、全心舒张末期容积指数(global end-diastolic volumn index,GEDVI)、胸腔内血容量指数(Intrathoracic blood volume index,ITBVI)相比液体复苏前均明显升高,血管外肺水指数(extravascular lung water index,EVLWI)明显降低(P<0.01);两组患者液体复苏后的急性生理学与慢性健康状况系统Ⅱ(acute physiology and chronic health eval-uationscoring system,APACHEⅡ)评分、心率(Heart rate,HR)相比液体复苏前均明显降低,平均动脉压(mean arte-rial pressure,MAP)、中心静脉压(CVP)均明显升高(P<0.01);并发症的发生和死亡率中观察组低于对照组(P>0.05);Logistic回归分析显示中重度吸入性损伤、呼吸系统并发症、泌尿系统并发症、感染和休克期不平稳是导致患者死亡的独立危险因素.结论采用"五根管道"联合PICCO监测技术有效缩短了抢救时间以及ICU的住院天数,降低并发症的发生率,安全性高,在临床上值得广泛应用.
Objective To analyze the clinical efficacy of"five channels"combined with pulse-indicating continuous cardiac output monitoring(PICCO)technology in bum patients and related factors affecting prognosis.Methods A total of 131 patients who were admitted to the Burn Department of the Affiliated Hospital of Southwest Medical University from March 2017 to June 2019 were randomLy divided into two groups,66 cases in the observation group and 65 cases in the control group.The treatment methods adopted by the patients are the same,and the"five pipes"strategy is adopted during the nursing process.The control group adopts conventional monitoring methods to guide fluid resuscitation,and the observation group is combined with PICCO monitoring technology.The hemodynamic indexes,fluid resuscitation time,complication rate,fatality rate and other indexes recovery time of the two groups were compared and analyzed.The prognostic factors were compared and the independent prognostic factors were analyzed by binary Logistic regression.Results Compared with the control group,the duration of hypoxia improvement,resuscitation time and ICU days in the observation group were significantly shortened(P<0.01).Compared with control group,the establishment of the observation group vein passage time,early effective treatment time no statistical difference(P>0.05),while the liquid recovery after cardiac index(CI),cardiac output(CO),end-diastolic volume index(GEDVI),with all my heart,intrathoracic blood volume index(ITBVI)were significantly higher than fluid resuscitation ago,blood vessels outside the lung water index(EYLWI)significaatly decreased(P<0.01);Two groups of patients with liquid recovery after acute physiology and chronic health system Ⅱ(APACHE Ⅱ)score,heart rate(HR)were significantly lower than liquid recovery ago,mean arterial pressure(MAP),central venous pressure(CVP)were significantly increased(P<0.01);The incidence of complications and mortality in the observation group was lower than that in the control group(P>0.05).Logistic regression analysis showed that moderate to severe inhalation injury,respiratory complications,urinary complications,infection and unstable shock stage were independent risk factors for death.Conclusion Ihe use of"five pipes"combined with PICCO monitoring technology effectively shortens the rescue time and the number of days of stay in the ICU,reduces the incidence of complications,and has high safety.It is worthy of widespread clinical application.
作者
夏凤
汪枫
XIA Feng;WANG Feng(Affiliated Hospital of Southwest Medical University,Plastic Surgery Department,Luzhou Sichuan 646000,China)
出处
《中国急救复苏与灾害医学杂志》
2021年第4期422-426,共5页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
四川省科学技术厅项目(编号:2015JY0224)。
