| 谢宇颖 陈一凡 王文博 孙东光 李海波.PiCCO 监测在感染性休克患者中的应用研究[J].,2014,14(35):6934-6937 |
| PiCCO 监测在感染性休克患者中的应用研究 |
| A Pilot Study of PiCCO Monitoring in the Patients with Septic Shock |
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| DOI： |
| 中文关键词: PiCCO 感染性休克 全心舒张末期容积指数 中心静脉压 |
| 英文关键词: PiCCO Septic shock Global end-diastolic volume index Central venous pressure |
| 基金项目:黑龙江省卫生厅课题(2007-299)；黑龙江省卫生厅课题（ 201 0-149） |
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| 中文摘要: |
| 目 的： 通过对感染性休克患者进行 PiCCO 监测，对比 CVP 与 GEDVI 对循环血容量的判断价值， 探讨 PiCCO 治疗方案在感
染性休克早期液体复苏中的应用 价值。 方法： 选取入 ICU 时 APACHEⅡ 大于 15 分的感染性休克患者 18 例， 行气管插管机械通
气。经锁骨下静脉置管， 经股动脉置入股动脉型热稀释导管，行 PiCCO 监测。 PiCCO 建立即刻为 T0， 每小时一次热稀释测量，连续
测量 6 小时(T1～ T6)。 以 CI、 GEDVI、 EVLWI 为 指导，按 PiCCO 治疗方案进行液体管理。 结果： 以 GEDVI 为金标准， CVP 对低血容
量判断的灵敏度、特异度、阳性预测值、阴 性预测值分别是 4%、 1 00%、1 00%、64%。 CVP 对高血容量判断的灵敏度、特异度、阳性预
测值、 阴 性预测值分别 是 17%、 55%、 21%、48%。 CVP 与 CI 无相关性， Δ CVP 与 Δ CI 无相关性， CVP 与 GEDVI 无相关性。 而
GEDVI 与 CI 明显相关， Δ GEDVI 与 Δ CI 明显相关。 GEDVI 与 EVLWI 有相关性， 而 CVP 与 EVLWI 无相关性.在各时点， CI 与
GEDVI 变化趋势基本一致， 而 CI 与 CVP 变化趋势相反。 结论： 对于需要机械通气的感染性休克患者， CVP 对低血容量判断的特
异度高， 但不灵敏。 GEDVI 能够更好的反映心脏的前负 荷， 对低血容量的判断敏感，更适合感染性休克病人的液体管理。 PiCCO
治疗治疗方案可以避免因 CVP 不敏感而导致的液体复苏不足现象的发生。 |
| 英文摘要: |
| Objective:To evaluate the predictive value of global end-diastolic volume index (GEDVI) and central venous pressure (CVP) in patients with sepsis, and to assess GEDVI guided fluid management during 6 hours.Methods:Prospective clinical study.
Eighteen cases of patients with sepsis were collected from the ICU department. They were facilitated endotracheal intubation and ventilation. A thermodilution femoral artery catheter was inserted into the femoral artery for PiCCO monitor. A central venous catheter was inserted into subclavian vein. Each patient had seven hemodynamic measurements within 6 hours after facilitating PiCCO monitor (T0～
T
6). Using PiCCO decision tree for advanced hemodynamic management, Colloids and crystalloids were administered to maintain CI,
GEDVI, and EVLWI as far as possible at nomal range.Results:The sensitivity, specificity, positive predictive value and negative predictive value of CVP with regard to volume depletion (GEDVI＜ 680 mL/m2), were 4%, 100%, 1 00% and 64%, and with regard to hypervolemia (GEDVI＞ 800) were 17%, 55%, 21% and 48%, respectively. CVP and Δ CVP did not correlate with CI and Δ CI. There was a
significant correlation between GEDVI and extravascular lung water index (r=0.384, P＜ 0.001)， but no correlation between CVP and extravascular lung water index (r=0.091 , P=0.323). During the study, CVP decreased but CI and GEDVI increased.Conclusion:The predictive values of GEDVI with regard to volume depletion were sensible. The predictive values of CVP were not sensible. GEDVI was more
appropriate for volume management in sepsis than CVP. |
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