连续心排血量容量监测调整连续性肾脏替代治疗脓毒症并急性呼吸窘迫综合征患者超滤率的作用观察.pdfVIP

344 内科急危重症杂志 2015 年第 21 卷第 5 期 连续心排血量容量监测调整连续性肾脏替代治疗服毒症 并急性呼吸窘迫综合征患者超滤率的作用观察 德阳市人民医院 邓林\德阳 618000 摘要 目的:观察脉搏轮廓温度稀释连续心排血量( PICCO) 监测对调整连续性肾脏替代治疗 (CRRT) 旅毒症 并发急性呼吸窘迫综合征( ARDS) 患者超滤率的作用。方法:选择 52 例采用 CRRT 的旅毒症并 ARDS 患者，随机分 成观察组和对照组，每组 26 例;对照纽采用 CVP 进行容量监测，并根据所监测的 CVP 值设置起滤率;观察纽给予 PICCO 监测，根据所监测的数值设置超滤率;许价 2 种监测方法对反映患者容量状况的效果。结果:治疗 96 h 后， 2 纽患者相关实验室指标均较治疗前有明显改善(PO.O日，且观察组患者的 APACHE 11 评分以及评估感染相关的 指标 PCT 及 CRP 水平均显著低于对照纽(均 P0.05) ;血管活性药物的剂量及使用时间、CRRT 治疗时间、机械通气时 间、ICU 住院夭数明显降低(均 P 0. 05) 。结论:PICCO 容量监测能准确坪估旅毒症并发 ARDS 患者的血容量状态;在 CRRT 过程中，根据患者临床症状和体征结合 PICCO 容量监浏有助于确定合适的超滤率，从而实现个体化的液体管理。 关键词连续心排血量容量监测 服毒症 急性呼吸窘迫综合征连续性肾脏替代治疗 中图分类号 R563. 8 ;R459. 5 文献标识码 A DOI 10. 1 1 768/nkjwzzzz20 1 50509 Effect of the puIse-indicator continuous cardiac output monitoring in adjusting uItrafiltration rate of patients with sep咀is-induced acute respiratoηdistress syndrome on continuous renaI replacement therapy DENG Li旷 . Peoples Hospital 0/ Deyang City , Deyang 618仪刀 ， China Abstract Objective: To explore the effect of the pulse-indicator continuous cardiac output (PICCO) monitoring in adjusting ultrafiltration rate in patients with sepsis-induced acute respiratory distress syndrome (ARDS) on continuous renal replacement therapy (CRRT). Methods: Fifty-two sepsis-induced ARDS patients on CRRT were selected and randomly di- vided into observation group and control group , 26 cases for each group. The control group received central venous pressure ( CVP) monitoring , and the ultrafiltration rate was set according to CVP , the observation group received volume monitoring by PICCO , and the ultrafiltration rate were given according to the monitoring data by PICCO. The effect of two kinds of mo- nitoring methods that reflect the volume status of the patients were compared. Results: Patients in both two groups showed improvement in some laboratoIγindexes 96 hours after treatment (P 0.05). PCT , CRP and APACHE 11 score were signif- icantly lower in the observation group than those of contr