本文選題：PICCO + 危重患者�。� 參考：《貴州醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討脈搏指示連續(xù)心輸出量(pulse indicate contour cardiac output,PICCO)監(jiān)測(cè)對(duì)指導(dǎo)重癥患者血液凈化的應(yīng)用價(jià)值。方法:采用前瞻性臨床研究方法,研究對(duì)象為2015年4月至2016年9月期間,貴陽(yáng)市第一人民醫(yī)院重癥醫(yī)學(xué)科收治的行連續(xù)性血液凈化(continuous blood purification,CBP)治療的患者,共為36例,將研究對(duì)象隨機(jī)分為2組,18例患者行中心靜脈、股動(dòng)脈穿刺后連接PICCO容量監(jiān)測(cè)儀監(jiān)測(cè)胸腔內(nèi)血容量指數(shù)(intrathoracic blood index,ITBI)、血管外肺水指數(shù)(extravascular lung water index,ELWI),為PICCO組,18例患者行中心靜脈穿刺后監(jiān)測(cè)中心靜脈壓(central venous pressure,CVP),為CVP組。PICCO組根據(jù)平均動(dòng)脈壓(mean arterial pressure,MAP)、ITBI、ELWI指導(dǎo)CBP期間的容量管理。CVP組根據(jù)MAP、CVP指導(dǎo)CBP期間的容量管理。記錄所有患者的治療前、治療后24h及72h的急性生理學(xué)與慢性健康狀況(acute physiology and chronic health evaluation,APACHE)Ⅱ評(píng)分、氧合指數(shù)(oxygenation index,OI)、低血壓發(fā)生例數(shù)、去甲腎上腺素用量及出入量。結(jié)果:PICCO組與CVP組治療前的APACHEⅡ評(píng)分、氧合指數(shù)比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)�；颊呓�(jīng)CBP治療后24h、72h時(shí),PICCO組患者的去甲腎上腺素用量和低血壓的發(fā)生率均明顯低于CVP組,APACHEⅡ評(píng)分明顯低于CVP組,氧合指數(shù)明顯高于CVP組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。PICCO組患者在0-24h、0-72h的總?cè)肓枯^CVP組明顯少,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。PICCO組和CVP組患者在0-24h、0-72h的液體平衡量為負(fù)平衡,同時(shí),PICCO組患者在0-24h、0-72h的液體負(fù)平衡量明顯比CVP組多(P0.05)。結(jié)論:PICCO監(jiān)測(cè)指標(biāo)較CVP更適用于指導(dǎo)重癥患者CBP期間的容量管理,有利于患者穩(wěn)定、順利的進(jìn)行治療,有助于病情改善。
[Abstract]:Objective: to investigate the value of pulse indicate contour cardiac output PICCOs in guiding blood purification in severe patients.Methods: from April 2015 to September 2016, 36 patients treated with continuous blood purification blood purificationCBPs were enrolled in the prospective clinical study, which were treated by the Department of intensive Medicine of the first people's Hospital of Guiyang City from April 2015 to September 2016.The subjects were randomly divided into two groups, 18 patients were treated with central vein,After femoral artery puncture, intrathoracic blood volume index intrathoracic blood index and extravascular lung water index were monitored by PICCO volume monitor after femoral artery puncture. 18 patients in PICCO group underwent central venous pressure monitoring after central venipuncture, according to the data of CVP group.Mean arterial pressuremap-mapi guided volume management during CBP. Volume management during CBP was guided by map-CVP in the CVP group.The acute physiology and chronic health evaluation and Apache 鈪，

本文編號(hào)：1746967