2019 年第 1 期 第 14 卷

脉搏指数连续心输出量监测下液体复苏对重症感染所致急性肾损伤患者内稳态指标及预后的影响

Effect of fluid resuscitation with pulse-induced contour cardiac output monitoring on homeostasis and prognosis in patients with acute renal injury caused by severe infection

作者：张华伟黄庆生方明星王智勇

英文作者：

单位：050000石家庄，河北医科大学第三医院重症医学科

英文单位：

关键词：急性肾衰竭；重症感染；脉搏指数连续心输出量监测；液体复苏；内稳态

英文关键词：

• 摘要：

• 【摘要】目的    探究脉搏指数连续心输出量监测（PiCCO）液体复苏对重症感染所致急性肾损伤（AKI）患者内稳态指标及预后的影响。方法    选取2017年10月至2018年2月河北医科大学第三医院收治的重症感染所致AKI患者64例，采用随机数字表法分为对照组和观察组，每组32例。对照组患者在漂浮导管（Swan-Ganz导管）监测下进行液体复苏，观察组患者在PiCCO指导下进行液体复苏。比较2组监测前后的血流动力学指标、内稳态指标、血清肌酐和尿素氮、临床预后以及监测复苏后AKI再发生率。结果    2组基线指标差异均无统计学意义（P＞0.05）。监测后第1、3天，观察组心率、中心静脉压明显低于对照组，平均动脉压、中心静脉血氧饱和度明显高于对照组；观察组血pH值、吸入氧浓度、血细胞比容、阴离子间隙、血乳酸水平明显低于对照组，血Na＋、Cl-、HCO-3浓度明显高于对照组；观察组血清肌酐和尿素氮水平明显低于对照组，差异均有统计学意义（均P＜0.05）。观察组重症监护病房住院时间、总住院时间、机械通气时间、院内死亡率均明显短于/低于对照组（均P＜0.05）。观察组监测复苏后AKI再发生率明显低于对照组［21.9%(7/32)比65.6%(21/32)］（P＜0.01）。结论    PiCCO液体复苏可有效改善重症感染所致AKI患者的血流动力学和内稳态，有利于降低复苏后AKI再发生率及院内死亡率，缩短住院时间。

• 【Abstract】Objective    To investigate the effect of fluid resuscitation with pulse-induced contour cardiac output(PiCCO) monitoring on homeostasis and prognosis in patients with acute renal injury（AKI） caused by severe infection. Methods    A total of 64 AKI patients caused by severe infection in the Third Hospital of Hebei Medical University from October 2017 to February 2018 were randomly divided into control group and observation group, with 32 cases in each group. The control group was treated with fluid resuscitation monitored by floating catheter(Swan-Ganz catheter). Fluid resuscitation was performed in the observation group with the guidance of PiCCO. Hemodynamic indexes, homeostasis indexes, serum creatinine and urea nitrogen, clinical prognosis and the reoccurrence of AKI after fluid resuscitation were analyzed. Results    Baseline indexes were similar between the two groups（P＞0.05）. On the 1st and 3rd day after resuscitation, heart rate and central venous pressure were significantly lower, mean arterial pressure and central venous oxygen saturation were significantly higher in the observation group than those in the control group; blood pH value, inspired oxygen fraction, hematocrit, anion gap and blood lactic acid level in the observation group were lower than those in the control group; blood contents of Na＋, Cl- and HCO-3 in the observation group were higher than those in the control group; serum levels of creatinine and urea nitrogen in the observation group were lower than those in the control group（all P＜0.05）. Intensive care unit stay time, total hospitalization time, mechanical ventilation time and the in-hospital mortality rate in the observation group were shorter/lower than those in the control group(all P＜0.05). Incidence of AKI after fluid resuscitation in the observation group was significantly lower than that in the control group［21.9%(7/32) vs 65.6%(21/32)］（P＜0.01）. Conclusion    Fluid resuscitation with PiCCO monitoring can effectively improve hemodynamics and homeostasis, reduce mortality and hospital stay time in patients with AKI caused by severe infection.