目的 探讨使用脉搏指数连续心输出量监测(PiCCO)中的容量指标指导液体复苏方案在感染性休克患者早期液体复苏中的应用价值.方法 选取明确诊断的感染性休克患者36例,PiCCO组根据监测的胸腔内血容积指数(ITBVI)和血管外肺水指数(EVLW)指导液体复苏,对照组以传统的中心静脉压(CVP)为指导的液体复苏目标.比较两组患者液体复苏治疗效果及预后的差异.结果 PiCCO组患者液体复苏治疗72 h后APACHEⅡ评分、血管活性药物评分和乳酸清除率均较对照组明显改善(P＜0.05);PiCCO组与对照组相比28天病死率、住院病死率、住ICU天数、机械通气治疗时间无明显差异(P＞0.05);PiCCO组的第一次液体复苏成功率较对照组明显提高(P＜0.05),血管活性药物使用时间也较短(P＜0.05).结论 PiCCO中的容量指标指导下的早期液体复苏治疗,可以提高液体复苏的成功率;EVLW指导液体复苏治疗,并不能改善患者的预后.%Objective To investigate the effect of fluid management strategy in sptic shock patients by in-trathoracic blood volume index( ITBVI) ^extravascular lung water( EVLW) . Methods 36 septic shock patients in Intensive Care Unit( ICU ) were enrolled in the study ,18 patients who were monitored with PiCCO, and patients who used ITBVI ,,EVLW as indicator of fluid management were enrolled into PiCCO group;the other patients who received traditional fluid management strategy were enrolled into control group. Results After 72h APACHE II score, vasopressor score, clearance rate of lactic and PaO2/FiO2 in PiCCO group improved more than those in control group. There were no differences in 28-Day mortality, in hospital mortality, hospitalization time in ICU and time of mechanical ventilation between two groups; Compared with the control group the recovery success rate of the frist time of shock was higher in PiCCO group, duration of vasopreeor was shorter in PiCCO group. Conclusion Capacity index monitoring by PiCCO directed fluid management strategy can elevate reversal rate, improve tissue perfusion early and reduce damage of organ. EVLW in fluid management strategy maybe reduce edema of lung and improve oxygenate, but no advantage in improving outcome.
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