新活素治疗严重脓毒症合并心力衰竭中的脉搏指示持续心输出量监测

宋宏; 潘丽萍; 邵振华

doi:10.7619/jcmp.202014033

新活素治疗严重脓毒症合并心力衰竭中的脉搏指示持续心输出量监测

复旦大学附属静安分院/上海市静安区中心医院重症医学科, 上海, 200040

详细信息

通讯作者:
潘丽萍,E-mail:panlp62@163.com

中图分类号: R541.6
计量
- 文章访问数: 453
- HTML全文浏览量: 99
- PDF下载量: 17
出版历程
- 收稿日期: 2020-04-04

Monitoring of pulse indicator continuous cardiac output in patients with severe sepsis complicated with heart failure treated by recombinant human brain natriuretic peptide

Department of Critical Care Medicine, Jing'an Branch Affiliated to Fudan University, Jing'an District Central Hospital, Shanghai, 200040

摘要

摘要: 目的探讨脉搏指示持续心输出量监测(PICCO)技术在新活素治疗严重脓毒症合并心力衰竭患者中的应用效果。方法选取40例严重脓毒症合并心力衰竭患者作为研究对象,随机分为研究组和对照组,每组20例。对照组采用常规心力衰竭治疗方案,研究组在对照组基础上加用新活素治疗。用PICCO监测仪分别测定2组患者用药前和用药后24、48、72 h的心脏指数(CI)、每搏量指数(SVI)、全心舒张末期容量指数(GEDI)、血管外肺水指数(ELWI)、全身血管阻力指数(SVRI)、全心射血分数(GEF)和心功能指数(CFI), 连续测3次并取平均值,同步记录心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、收缩压(SBP)和舒张压(DBP)结果。结果用药后24、48、72 h, 研究组患者SBP水平均显著低于对照组(P<0.05), 但2组HR、CVP、MAP、DBP水平比较,差异无统计学意义(P>0.05)。用药后24、48、72 h, 研究组CFI、ELWI水平优于对照组,差异有统计学意义(P<0.05); 与用药前比较,研究组CI、SVI和GEF水平于用药后24 h即显著升高(P<0.05), 而对照组CI、SVI水平则于用药后72 h显著升高, GEF水平于用药后48 h显著升高(P<0.05); 用药后, 2组患者GEDI和SVRI水平均降低,但用药前后比较,差异无统计学意义(P>0.05)。结论新活素可有效改善严重脓毒症合并心力衰竭患者的心功能,而PICCO技术是监测血流动力学和血容量有效且实用的方法。
- 新活素 /
- 脉搏指示持续心输出量监测 /
- 脓毒症 /
- 心力衰竭 /
- 心功能
Abstract: Objective To observe the application effect of pulse indicator continuous cardiac output(PICCO)for patients with severe sepsis complicated with acute heart failure treated by recombinant human brain natriuretic peptide. Methods A total of 40 patients with severe sepsis complicated with heart failures were selected as study objects, and were randomly divided into study group and control group, with 20 cases in each group. The control group was given anti-heart failure drugs, while the study group was additionally treated by recombinant human brain natriuretic peptide based on the control group. PICCO monitor was used to detect cardiac index(CI), stroke volume index(SVI), global end-diastolic volume index(GEDI), extracascular lung water index(ELWI), systemic vascular resistance index(SVRI), global ejection fraction( GEF), and cardiac function index(CFI)before drug use and at 24, 48 and 72 h after drug use in the two groups. Three continuous determination was performed, and average value was obtained. Heart rate(HR), mean arterial pressure(MAP), central venous pressure(CVP), systolic blood pressure(SBP), and diastolic blood pressure(DBP)were recorded at the same time. Results At 24, 48, 72 h after drug use, SBP in the study group was lower than that in the control group(P<0.05), but HR, CVP, MAP, DBP had no significant differences between the two groups(P>0.05). The levels of CFI and ELWI at 24, 48, 72 h after drug use were better than those in the control group(P<0.05). The levels of CI, SVI and CFI in the study group increased- significantly after 24 h of medication compared with medicine use before(P<0.05). The levels of CI and SVI were significantly increased at 72 h after medication, while the level of GEF was increased at 48 after medication in the contol group(P<0.05). After drug use, the levels of GEDI and SVRI were decreased after medication use, but no differences were found after medication use compared with medication use before(P>0.05). Conclusion Recombinant human brain natriuretic peptide can effectively improve cardiac function in heart failure patients with severe sepsis. PICCO technique is an effective and practical method for monitoring blood flow dynamics and blood volume.
- recombinant human brain natriuretic peptide /
- pulse indicator continuous cardiac output /
- sepsis /
- heart failure /
- cardiac function

HTML全文

参考文献(13)

PRESCOTT H C, ANGUS D C. Postsepsis morbidity[J]. JAMA, 2018, 319(1): 91-91.

中国医师协会急诊医师分会, 中国研究型医院学会休克与脓毒症专业委员会. 中国脓毒症/脓毒性休克急诊治疗指南(2018)[J]. 感染、炎症、修复, 2019, 20(1): 3-21.

吴丹, 金国强. 脓毒症心肌损害发病机制研究进展[J]. 南昌大学学报: 医学版, 2010, 50(12): 119-122.

陈艳明, 王士雯. 脓毒症时心功能损害机制的研究进展[J]. 心脏杂志, 2009, 21(1): 122-123.

ZANOTTI-CAVAZZONI S L, HOLLENBERG S M. Cardiac dysfunction in severe Sepsis and septic shock[J]. Curr Opin Crit Care, 2009, 15(5): 392-397.

KRUM H, LIEW D. New and emerging drug therapies for the management of acute heart failure[J]. Intern Med J, 2003, 33(11): 515-520.

索娅, 鲍乾坤, 李广平. 利钠肽系统增强药物在心力衰竭治疗中的研究进展[J]. 山东医药, 2019, 59(28): 110-114.

重组人脑利钠肽多中心研究协作组. 重组人脑利钠肽治疗心力衰竭安全性和疗效的开放性随机对照多中心临床研究[J]. 中华心血管病杂志, 2011, 39(4): 305-308.

符孝磊, 张慧. 重组人脑利钠肽可有效治疗慢性心力衰竭急性失代偿性重症[J]. 基因组学及应用生物学, 2019, 38(8): 3786-3790.

王凤霞, 刘永国, 郭浩强, 等. 心肺联合超声与脉搏指数连续心输出量监测在心力衰竭患者体液管理中的应用[J]. 中国心血管杂志, 2019, 24(5): 430-433.

金光勇, 梁栋诚, 林乐清, 等. PICCO在脓毒症液体复苏的应用进展[J]. 医学研究杂志, 2019, 48(4): 164-167.

赵东坡, 孙小燕, 冯倩, 等. 新活素在难治性心力衰竭治疗中的应用研究[J]. 河北医学, 2018, 24(1): 122-125.

王广军. 急性心肌梗死伴心力衰竭给予小剂量速尿配合新活素的临床应用研究[J]. 现代诊断与治疗, 2017, 28(17): 3219-3220.

施引文献(13)

期刊类型引用(11)

1.	李柳芳. 尿路结石患者术后发生泌尿系感染的病原学分析及防护措施探究. 基层医学论坛. 2023(23): 53-55+58 . 百度学术
2.	周煦东，李辰，吕晨冉. 输尿管软镜碎石术中不同肾盂内压对患者术后肾功能、疼痛程度、尿mALB及不良反应的影响. 临床和实验医学杂志. 2022(03): 310-313 . 百度学术
3.	王莉，武强，蒲巍林，葛君，杲飞莹，张国泰，卢丹. 有症状的妊娠期合并肾积水临床特点及治疗方法评价. 实用临床医药杂志. 2022(09): 45-49 . 本站查看
4.	李升平，陈如，马锋，石永柱，周俊. 经输尿管软镜取石术后院内感染的病原学特征及危险因素探讨. 国际泌尿系统杂志. 2021(01): 53-56 . 百度学术
5.	张钦尧. 术前留置输尿管支架管(双J管)对输尿管软镜碎石术治疗肾或输尿管上段结石治疗效果的影响分析. 临床研究. 2020(02): 74-75 . 百度学术
6.	沈海深. 经输尿管镜钬激光碎石术对输尿管结石患者肾功能指标及结石残留情况的影响. 航空航天医学杂志. 2020(04): 437-439 . 百度学术
7.	赵国斌，凌海滨，刘鑫，唐玉红，苏宏伟，唐立东，冯超，李朝阳，李向东. 输尿管软镜碎石术202例手术时间的影响因素. 安徽医药. 2020(07): 1317-1320 . 百度学术
8.	陈亮，刘勇，刘强，李金祥，李新会，李昱昊. 输尿管软镜治疗输尿管结石患者术后感染高危因素分析. 中国性科学. 2020(10): 110-113 . 百度学术
9.	张超，刘军. 输尿管镜下钬激光碎石术治疗输尿管结石的临床疗效分析. 实用妇科内分泌电子杂志. 2020(05): 163+170 . 百度学术
10.	高志光. 输尿管镜下钬激光碎石术治疗输尿管结石的临床疗效观察. 心理月刊. 2019(01): 171 . 百度学术
11.	蒋政干，鲁卫民，刚向辉，王祺. 不同手术体位多镜联合治疗复杂性尿路结石疗效研究. 创伤与急危重病医学. 2019(04): 254-255 . 百度学术