|本期目录/Table of Contents|

[1]崔广清,冒秀宏,孙卫和,等.PiCCO指导重症患者液体管理及临床预后的评价[J].医学研究与战创伤救治(原医学研究生学报),2015,17(02):122-136.[doi:10.3969/j.issn.1672-271X.2015.02.004]
　CUI Guang-qing,MAO Xiu-hong,SUN Wei-he,et al.Study of the fluid responsiveness and outcomes of patients who receive PiCCO[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2015,17(02):122-136.[doi:10.3969/j.issn.1672-271X.2015.02.004]
点击复制

PiCCO指导重症患者液体管理及临床预后的评价()
分享到62.8K

《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第17卷
期数:
2015年02期
页码:
122-136
栏目:
出版日期:
2015-04-22

文章信息/Info

Title:
Study of the fluid responsiveness and outcomes of patients who receive PiCCO
作者:
崔广清; 冒秀宏; 孙卫和; 柳小霞
224200 江苏盐城，南通大学附属东台医院重症医学科
Author(s):
CUI Guang-qing;  MAO Xiu-hong;  SUN Wei-he;  LIU Xiao-xia.
ICU， Dongtai Hospital Affiliated to Nantong University， Yancheng， Jiangsu 224200， China
关键词:
热稀释技术; 液体复苏; 脉搏指示连续心排出量监测; 肺动脉导管; 预后
Keywords:
thermodilution technology;  fluid resuscitation;  pulse contour cardiac output;  the pulmonary artery cathete;  outcome
分类号:
R459.7
DOI:
10.3969/j.issn.1672-271X.2015.02.004
文献标志码:
A
摘要:
目的 回顾性探讨脉搏指示连续心排出量监测（PiCCO）对重症患者指导液体复苏及评价预后的作用，并与肺动脉导管（PAC）比较。方法 收集2010年1月-2014年1月南通大学附属东台人民医院ICU住院诊治并放置PiCCO或PAC的重症患者96例，其中PiCCO组44例，PAC组52例，记录数据包括两组患者人口统计学资料、血流动力学参数、24 h液体出入量、机械通气时间、无机械通气时间（VFDs）、28 d内非ICU住院时间、总住院时间及院内死亡率等指标，采用Fisher's精确检验或Mann-Whitney检验进行两组间比较，进一步采用多元回归模型进行多因素校正。结果 分析置管原因，感染性休克是放置PiCCO的主要原因（52.2%），心源性休克是放置PAC的主要原因（57.7%）。PiCCO组与PAC组7日内24 h液体平衡量分别为650（-120，1400）、350（-570，1060），P=0.001，第2日液体平衡量比较差异具有统计学意义（FBPiCCO=250及FBPAC=550，P=0.012），且PiCCO组中置管并发症及VFDs均显著少于PAC组（P＜0.05）。采用多元回归模型发现，PiCCO及PAC均不是影响上述临床结果的独立预测因子。结论 PiCCO对重症患者指导液体复苏及评价预后中的作用并不优于PAC，且PiCCO监测下过度补液反而会增加院内死亡率。
Abstract:
Objective A prospective study was conducted to compare the fluid responsiveness and outcomes of patients who receive haemodynamic monitoring with either the pulmonary artery catheter (PAC) or pulse contour cardiac output (PiCCO) technology. Methods A cohort of 96 critically ill patients who received haemodynamic monitoring by PAC or PiCCO according to physician preference in intensive care units (ICUs) from 2010 January to 2014 January. Data were collected on haemodynamics， demographic features， daily fluid balance， mechanical ventilation days， ICU days， hospital days， and hospital mortality. The Fisher's exact test and Mann-Whitney test were used for nominal values and numerical variables， respectively， to compare variables in patients managed with PiCCO and PAC and confounding factors were adjusted by using the multiple regression model. Results Mean daily fluid balance was significantly greater during PiCCO monitoring (650 versus 350， P=0.001) and fluid balance compared with patients with PAC and fluid balance was found to be significantly different on day two (FBPiCCO=250 versus FBPAC=550， P=0.012). However， after multiple regression analysis， we found no significant effect of monitoring technique on mean daily fluid balance， mechanical ventilation free days， ICU-free days， or hospital mortality. Conclusion The choice of PiCCO monitoring did not influence major outcomes than PAC and overtreatment may be detrimental， whereas a positive fluid balance was a significant independent predictor of outcome.

参考文献/References:

［1］Sakr Y，Vincent JL，Reinhart K，et al.Sepsis occurrence in acutely Ⅲ patients investigators.High tidal volume and positive fluid balance are associated with worse outcome in acute lung injury［J］.Chest，2005，128(5)：3098-3108.
［2］Uchino S，Bellomo R，Morimatsu H，et al.Pulmonary artery catheter versus pulse contour analysis：a prospective epidemiological study［J］.Crit Care，2006，10(6)：R174.
［3］National Heart，Lung，Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Networkl.Comparison of two fluid-management strategies in acute lung injury［J］.N Engl J Med，2006，354(24)：2564-2575.
［4］孙宝迪，刘红梅，聂时南.限制性液体复苏在创伤失血性休克中的进展［J］.东南国防医药，2012，14(2)：145-147.
［5］Dovern E，Mende MR，Elderson NJ，et al.Successful treatment of massive pulmonary embolism using a pulmonary artery catheter during prolonged normothermic cardiopulmonary resuscitation［J］.Acute Med，2014，13(3)：118-120.
［6］Headley JM.Pulmonary artery catheters and assessment of pulmonary artery wedge pressure［J］.Crit Care Nurse，2014，34(4)：85-86.
［7］Sotomi Y，Sato N，Kajimoto K，et al.Impact of pulmonary artery catheter on outcome in patients with acute heart failure syndromes with hypotension or receiving inotropes：from the ATTEND Registry［J］Int J Cardiol，2014，172(1)：165-172.
［8］Gopal S，Do T，Pooni JS，et al.Validation of cardiac output studies from the mostcare compared to a pulmonary artery catheter in septic patients［J］.Minerva Anestesiol，2014，80(3)：314-323.
［9］Sridhar A，Subramanyan R，Cherian KM.Coronary artery to pulmonary artery communications in pulmonary atresia with ventricular septal defect［J］.Indian Heart J，2013，65(5)：636-638.
［10］Eichhorn V，Goepfert MS，Eulenburg C，et al.Comparison of values in critically ill patients for global end-diastolic volume and extravascular lung water measured by transcardiopulmonary thermodilution：a meta-analysis of the literature［J］.Med Intensiva，2012，36(7)：467-474.
［11］Hofhuizen C，Lansdorp B，van der Hoeven JG，et al.Validation of noninvasive pulse contour cardiac output using finger arterial pressure in cardiac surgery patients requiring fluid therapy［J］.J Crit Care，2014，29(1)：161-165.
［12］Tagami T，Kushimoto S，Yamamoto Y，et al.Validation of extravascular lung water measurement by single transpulmonary thermodilution：Human autopsy study［J］.Crit Care，2010，14(5)：R162.
［13］Bektas RN，Kutter AP，Hartnack S，et al.Evaluation of a minimally invasive non-calibrated pulse contour cardiac output monitor (FloTrac/Vigileo) in anaesthetized dogs［J］.Vet Anaesth Analg，2012，39(5)：464-471.
［14］Teboul JL，Monnet X，Richard C.Weaning failure of cardiac origin：recent advances［J］.Crit Care，2010，14(2)：R211.
［15］Bigatello LM，Kistler EB，Noto A.Limitations of volumetric indices obtained by trans-thoracic thermodilution［J］.Minerva Anestesiol，2010，76(11)：945-949.
［16］Cannesson M，Pestel G，Ricks C，et al.Hemodynamic monitoring and management in patients undergoing high risk surgery：a survey among North American and European anesthesiologists［J］.Crit Care，2011，15(4)：R197.
［17］Neumann P.Extravascular lung water and intrathoracic blood volume：double versus single indicator dilution technique［J］.Intensive Care Med，1999，25(2)：216-219.
［18］Mutoh T，Kazumata K，Terasaka S，et al.Impact of transpulmonary thermodilution-based cardiac contractility and extravascular lung water measurements on clinical outcome of patients with Takotsubo cardiomyopathy after subarachnoid hemorrhage：a retrospective observational study［J］.Crit Care，2014，18(4)：R482.
［19］孟新科，邓跃林.APACHEⅡ与SAPSⅡ评分系统对急诊内科.危重患者病情评估价值的比较［J］.中国危重病急救医学，2001，13(12)：751-754.
［20］Nseir S，Favory R，Jozefowicz E，et al.Antimicrobial treatment for ventilator-associated tracheobronchitis：a randomized，controlled，multicenter study［J］.Crit Care，2008，12(3)：R62.
［21］Eichhorn V，Goepfert MS，Eulenburg C，et al.Comparison of values in critically ill patients for global end-diastolic volume and extravascular lung water measured by transcardiopulmonary thermodilution：a meta-analysis of the literature［J］.Med Intensiva，2012，36(7)：467-474.
［22］Huber W，Umgelter A，Reindl W，et al.Volume assessment in patients with necrotizing pancreatitis：a comparison of intrathoracic blood volume index，central venous pressure，and hematocrit，and their correlation to cardiac index and extravascular lung water index［J］.Crit Care Med，2008，36(8)：2348-2354.
［23］Michard F，Alaya S，Zarka V，et al.Global end-diastolic volume as an indicator of cardiac preload in patients with septic shock［J］.Chest，2003，124(5)：1900-1908.
［24］Sakka SG，Ruhl CC，Pfeiffer UJ，et al.Assessment of cardiac preload and extravascular lung water by single transpulmonary thermodilution［J］.Intensive Care Med，2000，26(2)：180-187.
［25］Wiesenack C，Prasser C，Keyl C，et al.Assessment of intrathoracic blood volume as an indicator of cardiac preload：single transpulmonary thermodilution technique versus assessment of pressure preload parameters derived from a pulmonary artery catheter［J］.J Cardiothorac Vasc Anesth，2001，15(5)：584-588.

相似文献/References:

[1]钟善传,王丽,周斌,等.冻干血浆在平战时的应用与研究进展[J].医学研究与战创伤救治(原医学研究生学报),2022,24(3):310.[doi:10.3969/j.issn.1672-271X.2022.03.019]
　ZHONG Shan-chuan,WANG Li,ZHOU Bin,et al.Application and research progress of freeze dried plasma in peacetime and wartime[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2022,24(02):310.[doi:10.3969/j.issn.1672-271X.2022.03.019]

备注/Memo

备注/Memo:
江苏省盐城市科技计划项目（YK2011052）
更新日期/Last Update: 2015-03-20