PICCO容量监测调整连续性肾脏替代治疗脓毒症并发ARDS患者的临床.doc

PICCO容量监测调整连续性肾脏替代治疗脓毒症并发ARDS患者的临床研究 邓林 德阳市人民医院重症医学科 618000 TEL[摘要] 目的 观察脉波轮廓温度稀释连续心排血量（pulse-indicator continuous cardiac output，PICCO）监测对调整连续性肾脏替代治疗（continuous renal replacement therapy，CRRT）脓毒症并发急性呼吸窘迫综合征患者超滤率的作用。方法 选择52例采用连续性肾脏替代治疗的脓毒症并发急性呼吸窘迫综合征患者，随机分成观察组和对照组，每组26例；对照组采用CVP进行容量监测，并根据所监测的CVP值设置超滤率；观察组给予PICCO监测，根据所监测的数值设置超滤率；评价两种监测方法对反映患者容量状况的效果。结果 与对照组比较，观察组的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住院天数明显降低(P0.05)。结论 PICCO容量监测能准确评估患者的血容量状态；在CRRT过程中，根据患者临床症状和体征结合PICCO容量监测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] PICCO容量监测；脓毒症；急性呼吸窘迫综合征；连续性肾脏替代治疗 Clinical observation in patients with sepsis-induced ARDS by continuous renal replacement therapy according to volume monitoring by PICCO Deng Lin ICU of People’s Hospital of Deyang City 618000 Abstract Objective: To explore the effect on the ultrafiltration rate in patients with sepsis-induced ARDS by continuous renal replacement therapy according to volume monitoring by PICCO. Methods: The 52 sepsis-induced ARDS patients by continuous renal replacement therapy were selected and randomly divided into observation group and control group, each group contained 26 cases. The control group were received Central venous pressure monitoring,and the ultrafiltration rate were set according to the Central venous pressure; the observation group were received volume monitoring by PICCO, and the ultrafiltration rate were given according to the Monitoring datas of pulse-induced contour cardiac output.the Effect of two kinds of monitoring methods to reflect the volume status of the patients were compared. Results: compared with control group,the use of dose and time about vasoactive drug、the time of CRRT、the hospitalization time of ICU were significantly decreased in observation group (P0.05). Conclusion: The volume monitoring of PICCO can accurately assess blood volume status of the patients; in the process of CRRT, according to the clinical symptoms and signs of patients with PICCO volume monitoring helps to identify suita