标题：PICCO在重症急性胰腺炎患者液体复苏中的应用

      作者：魏旭升，况刚，王友华，胡大碧，陈勇
    (重庆市大足区人民医院重症医学科，重庆 402360)

      卷次： 2016年27卷16期

      【摘要】 目的 探讨重症急性胰腺炎患者在脉搏轮廓温度稀释连续心排量测量(PICCO)监测下的液体复苏效
果。方法 将我科2012年1月至2014年1月收治的47例SAP患者作为研究对象，根据是否应用PICCO监测分为
观察组25例和对照组22例，观察组运用PICCO监测指导液体复苏，而对照组根据心率、血压、中心静脉压及尿量指导
液体复苏；比较两组患者治疗后6 h、12 h、24 h的中心静脉压、平均动脉血压、心率、中心静脉血氧饱和度，并比较两组
患者住 ICU时间、机械通气时间、多器官功能障碍综合征(MODS)发生例数及28 d死亡人数。结果 治疗后6 h，两组
患者的中心静脉压[(8.24±2.18) mmHg vs (6.41±2.30) mmHg]、平均动脉压[(79.40±6.63) mmHg vs (71.05±4.60) mmHg]、
中心静脉血氧饱和度[(70.57±6.49)% vs (63.03±5.61)%]比较，观察组均高于对照组，心率[(109.07±12.35)次/min vs
(121.25±14.31)次/min]比较，观察组低于对照组，差异均有统计学意义(P<0.05)；治疗后12 h，观察组患者的心率为
(103.51±9.07)次/min，低于对照组的(112.37±11.23)次/min，中心静脉血氧饱和度为(72.25±7.63)%，高于对照组
的 (66.29±6.67)%，差异均有统计学意义(P<0.05)；治疗后 24 h，两组患者的中心静脉压[(9.16±1.28 ) mmHg vs
(7.59±1.68) mmHg]、平均动脉压[(85.46±10.36) mmHg vs (77.56±12.11) mmHg]比较，观察组均高于对照组，差异有统
计学意义(P<0.05)。两组患者住ICU时间[(9.27±1.39) d vs (13.38±2.27) d]、机械通气时间[(4.62±0.98) d vs (6.36±1.20) d]、
MODS发生率(16.00% vs 45.45%)比较，观察组均低于对照组，差异均有统计学意义(P<0.05)，但28 d死亡率两组患
者比较，差异无统计学意义(P>0.05)。结论 重症急性胰腺炎患者PICCO监测下的液体复苏疗效更佳，其能及时、
有效的稳定血流动力学，缩短机械通气时间、降低MODS的发生率，减少住 ICU时间，值得临床推广应用。

      【关键词】 重症急性胰腺炎；脉搏轮廓温度稀释连续心排量测量；血容量；液体复苏

      【中图分类号】 R657.5+1 【文献标识码】 A 【文章编号】 1003—6350（2016）16—2599—04


Application of PICCO for fluid resuscitation of patients with severe acute pancreatitis.
WEI Xu-sheng, KUANG
Gang, WANG You-hua, HU Da-bi, CHEN Yong. Department of Severe Medical Science, the People's Hospital of Dazu
District of Chongqing, Chongqing 402360, CHINA

【Abstract】 Objective To investigate the effect of pulse contour temperature dilution continuous cardiac output
measurement (PICCO) monitor on the fluid resuscitation in patients with severe acute pancreatitis (SAP). Methods A
total of 47 consecutive patients with severe acute pancreatitis were enrolled in this study from January 2012 to Janu-
ary 2014. According to under the PICCO monitor or not, all the subjects of study were divided into the observation
group with 25 cases and the control group with 22 cases. In the observation group, PICCO monitor was used to guide
fluid resuscitation, while heart rate (HR), blood pressure (BP), central venous pressure (CVP) and urine were used to
guide fluid resuscitation in the control group. The CVP, mean arterial pressure (MAP), HR, central venous oxyhemo-
globin saturation (ScvO2) of the patients 6, 12, 24 hours after treatment in two groups were compared. The ICU stay
time, total time of mechanical ventilation, cases of multiple organ dysfunction syndrome (MODS) and 28 days mortal-
ity in two groups were compared. Results 6 hours after treatment, the CVP, MAP, ScvO2 of the observation group
[(8.24±2.18) mmHg, (79.40±6.63) mmHg, (70.57±6.49)%, respectively] were significantly higher than those in the
control group [(6.41±2.30) mmHg, (71.05±4.60) mmHg, (63.03±5.61)%, respectively] (P<0.05), while HR of the observa-
tion group [(109.07±12.35) times/min] was significantly lower than that of the control group [(121.25±14.31) times/min]
(P<0.05). 12 hours after treatment, the HR of the observation group [(103.51±9.07) times/min] was significantly lower than
that of the control group [(112.37±11.23) times/min] (P<0.05), while ScvO2 of the observation group [(72.25±7.63)%] was
significantly higher than that of the control group [(66.29±6.67)] (P<0.05). 24 hours after treatment, the CVP, MAP in
the observation group [(9.16±1.28) mmHg, (85.46±10.36) mmHg, respectively] were significantly higher than those in
the control group [(7.59±1.68) mmHg, (77.56±12.11) mmHg, respectively] (P<0.05). The incidence rate of MODS, ICU
stay time, mechanical ventilation time in the observation group [16.00%, (9.27±1.39) days, (4.62±0.98) days, respective-
ly] were significantly less than those in the control group [45.45%, (13.38±2.27) days, (6.36±1.20) days, respectively]
(P<0.05). There was no significant difference between two groups in 28 days' mortality (P>0.05). Conclusion For pa-
tien