發(fā)布時間：2018-05-11 06:08

  本文選題：PiCCO + 生物學(xué)指標(biāo)��； 參考：《延邊大學(xué)》2017年碩士論文

【摘要】：目的:探討脈搏指示劑連續(xù)心排出量監(jiān)測(Pulse index Continuous Cardiac Output,PiCCO)對膿毒性休克患者的影響及早期血清生物學(xué)指標(biāo)對膿毒性休克診斷及預(yù)后判斷的影響。方法:選取2014年1月至2016年12月期間的延邊大學(xué)附屬醫(yī)院重癥醫(yī)學(xué)科收治的膿毒性休克患者58例,選擇其中重癥監(jiān)護(hù)病房(Intensive care unit,ICU)住院時間大于24小時的患者,根據(jù)是否行PiCCO監(jiān)測指導(dǎo)治療,分為對照組(24例)、PiCCO組(24例)。所有膿毒性休克患者(58例),根據(jù)其預(yù)后情況分為存活組(28例)、死亡組(30例)。收集對照組,PiCCO組患者一般資料、急性生理與慢性健康評分(Acute physiology and chronic health evaluation II,APCHEII評分)、血清學(xué)指標(biāo)水平,兩組患者的ICU住院時間、死亡率,中心靜脈壓(Central Venous Pressure,CVP),停用血管活性藥百分率,治療前3天總輸液量。PiCCO組第1、2、3天的連續(xù)指標(biāo)。收集存活組,死亡組患者年齡、入院時APCHEII評分、17項血清學(xué)指標(biāo)。結(jié)果:1.對照組、PiCCO組患者年齡、性別,入院時SBP/DBP、APACHEII評分等無統(tǒng)計學(xué)意義(P0.05);2.治療過程中,PiCCO監(jiān)測指導(dǎo)治療使血流動力學(xué)指標(biāo)(CI、GEDI、ELWI、SVRI)維持在接近于正常值的范圍內(nèi)。治療3天后,與對照組比較,PiCCO組患者72小時總輸液量雖然無統(tǒng)計學(xué)意義,但是在數(shù)值上明顯減少,且PiCCO組能更早的達(dá)到血流動力學(xué)穩(wěn)態(tài),72小時內(nèi)有更高的血管活性藥物停用率,具有統(tǒng)計學(xué)意義(P0.01);與對照組比較,經(jīng)治療后,PiCCO組患者具有更低APACHEII評分及更短的ICU住院時間,差異具有統(tǒng)計學(xué)意義(P0.05);兩組患者死亡率比較無統(tǒng)計意義;治療第3天,經(jīng)比較兩組患者的Lac、IL-6、NGAL、NT-proBNP、sCysc、PCT、sCRP等指標(biāo)的水平差異具有統(tǒng)計學(xué)意義(P0.05或P0.01),PiCCO組患者具有更低的上述炎癥介質(zhì)和細(xì)胞因子水平。3.利用受試者工作特征曲線(Receive operating characteristic curve,ROC 曲線)回顧性分析CK-MB、NT-proBNP等17項細(xì)胞因子、炎癥介質(zhì)與膿毒性休克(58例)的關(guān)系,結(jié)果發(fā)現(xiàn):IL-6、NGAL具有早期診斷膿毒性休克的預(yù)測價值,剩余指標(biāo)中關(guān)系較大的依次是sCysc、CK-MB、UA。4.通過比較生存組與死亡組患者入院時APACHEII評分、Lac、sCysc等17項指標(biāo)與預(yù)后的關(guān)系。結(jié)果顯示APACHEII評分、Lac、sCysc、UA、NGAL、IL-6等6項指標(biāo)與患者的預(yù)后密切相關(guān),與對照組相比,存活組患者具有更低的APACHEII評分及Lac、sCysc、UA、NGAL、IL-6水平,差異具有統(tǒng)計學(xué)意義(P0.05或P0.01)。而兩組患者的年齡、CK-MB、NT-proBNP、Myo、cTnI、PCT、WBC、sCRP、D-D、NEUT%、PLT、DBIL、sCr、TBIL、BUN等指標(biāo)比較,差異均無統(tǒng)計學(xué)意義(這0.05)。分析58例膿毒性休克患者的基本資料及生物學(xué)指標(biāo),Logistic二元回歸分析顯示,APACHEII評分,IL-6、NGAL、Lac、sCysc、UA、NGAL是膿毒性休克死亡相關(guān)的因素(P值均0.05)。結(jié)論:1.PiCCO監(jiān)測指導(dǎo)治療有助于膿毒性休克患者早期達(dá)到血流動力學(xué)的穩(wěn)態(tài),減輕體內(nèi)的炎癥反應(yīng)程度,具有更低的APACHE Ⅱ評分,最終縮短了膿毒性休克患者的ICU住院時間。2.IL-6、NGAL、sCysc、CK-MB、UA具有早期診斷膿毒性休克的預(yù)測價值,其中IL-6早期診斷預(yù)測價值更高,NGAL具有更高的敏感性和特異性。3.APACHEⅡ評分、血Lac、sCysc、UA、NGAL、IL-6水平與膿毒性休克患者預(yù)后相關(guān),NGAL可能成為判斷膿毒性休克預(yù)后的一個新的生物學(xué)標(biāo)記物。
[Abstract]:Objective: To investigate the effect of Pulse index Continuous Cardiac Output (PiCCO) on septic shock and the effect of early serum biological indicators on the diagnosis and prognosis of septic shock. Methods: the collection of the Department of intensive medicine from January 2014 to December 2016, the Department of severe medicine, the Affiliated Hospital of Yanbian University. 58 patients with septic shock were treated with Intensive care unit (ICU), which were hospitalized for more than 24 hours. According to whether or not PiCCO monitoring was used, the patients were divided into control group (24 cases), PiCCO group (24 cases) and all septic shock patients (58 cases), and the prognosis was divided into survival group (28 cases) and death group (30 cases). The control group, the general data of the PiCCO group, the acute physiological and chronic health score (Acute physiology and chronic health evaluation II, APCHEII score), the level of serological index, the hospitalization time of the two groups of patients, the mortality, the central venous pressure (Central Venous), the percentage of vasoactive drugs, and the total of the 3 days before the treatment. The continuous indexes of.PiCCO group 1,2,3 days of the infusion volume were collected. The survival group, the age of the death group, the APCHEII score of the admission and the 17 serological indexes. Results: the 1. control group, the age, sex, SBP/DBP, APACHEII score in the group PiCCO were not statistically significant (P0.05); and during the 2. treatment, the PiCCO monitoring and guidance therapy made the hemodynamic index. (CI, GEDI, ELWI, SVRI) was maintained within the range of close to normal values. After 3 days of treatment, compared with the control group, the total infusion volume of the 72 hours in the PiCCO group was not statistically significant, but the value was significantly reduced, and the PiCCO group was able to reach hemodynamic homeostasis earlier, with a higher vasoactive drug discontinuation rate within 72 hours, with statistics. Significance (P0.01); compared with the control group, after treatment, the patients in group PiCCO had lower APACHEII score and shorter ICU hospitalization time, the difference was statistically significant (P0.05); the two groups of patients had no statistical significance; the levels of Lac, IL-6, NGAL, NT-proBNP, sCysc, PCT, sCRP, and other indicators were compared on the third day of treatment. Statistical significance (P0.05 or P0.01), group PiCCO patients had lower levels of the above inflammatory mediators and cytokine levels.3. using the subject work characteristic curve (Receive operating characteristic curve, ROC curve) retrospective analysis of CK-MB, NT-proBNP and other 17 cytokines, inflammatory mediators and septic shock (58 cases), the results found: IL -6, NGAL has the predictive value for the early diagnosis of septic shock. The remaining index of the remaining indexes is sCysc, CK-MB, and UA.4. through the comparison of the relationship between the APACHEII score, Lac, sCysc, and other 17 indexes of the survival group and the death group, Lac, sCysc and so on. The results show that the APACHEII score, Lac, sCysc, UA, sCysc and so on are the 6 indexes and the prognosis of the patients. Compared with the control group, the patients in the survival group had lower APACHEII scores and Lac, sCysc, UA, NGAL, IL-6 levels, and the differences were statistically significant (P0.05 or P0.01). The differences were not statistically significant (0.05) in the two groups of patients. The basic data and biological indexes of 58 patients with septic shock were analyzed. The Logistic two regression analysis showed that the APACHEII score, IL-6, NGAL, Lac, sCysc, UA, NGAL were the factors associated with the death of septic shock (P is 0.05). Conclusion: 1.PiCCO monitoring and guidance can help the patients with septic shock to reach the homeostasis of hemodynamic early and alleviate the early stage of the septic shock. The degree of inflammation in the body has a lower APACHE II score, which eventually shortens the ICU hospitalization time of septic shock patients.2.IL-6, NGAL, sCysc, CK-MB, and UA has a predictive value for early diagnosis of septic shock, of which the early diagnostic value of IL-6 is higher, NGAL has a higher sensitivity and specificity of.3.APACHE II score, Lac, sC. YSC, UA, NGAL and IL-6 levels are associated with the prognosis of septic shock. NGAL may be a new biomarker for predicting the prognosis of septic shock.

【學(xué)位授予單位】：延邊大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R459.7

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