PICCO技术在老年重型颅脑损伤患者液体管理中的应用研究

目的：研究PICCO技术（脉搏轮廓温度稀释连续心排量）对老年重型颅脑损伤患者的疗效影响。方法：选取2010年10月-2013年12月本院重症医学科收治的38例老年重型颅脑损伤患者,按照随机数字表法将其分为对照组和研究组各19例,患者不同程度合并心肺功能不全、糖尿病、高血压病、营养不良等慢性疾病。对照组给予CVP监测补液,研究组应用PICCO监测血流动力学指标进行液体管理,观察比较两组患者治疗前及治疗后1周GCS评分、呼吸机辅助通气时间、ICU住院时间、急性肺水肿发生率和死亡率及治疗1个月后的恢复情况。结果：两组治疗前的GCS评分比较差异无统计学意义（P〉0.05）,研究组治疗后1周的GCS评分明显高于对照组,差异有统计学意义（P〈0.05）。研究组的呼吸机辅助通气时间、ICU住院时间均明显少于对照组,急性肺水肿发生率及死亡率均明显低于对照组,差异均有统计学意义（P〈0.05）。经治疗1个月后,研究组的恢复良好率68.4%明显高于对照组的31.6%,差异有统计学意义（P〈0.05）。结论：PICCO监测血流动力学指标进行液体管理能改善老年重型颅脑损伤患者预后,值得临床上推广。

Application Research of PICCO System Monitoring on the Old Patients with Severe Brain Injury

Objective：To research the curative effect of PICCO system monitoring on the old patients with severe brain injury.Method：38 old patients with severe brain injury were selected in our ICU from October 2010 to December 2013,they were randomly divided into the control group and the study group,19 cases in each group.Patients with cardiopulmonary insufficiency,different level of chronic diseases such as diabetes,hypertension,malnutrition.The control group was given CVP monitoring rehydration,and the study group was given PICCO hemodynamic monitoring indicators for fluid management.The GCS score before treatment and 1 week after treatment,breathing machine auxiliary ventilation time and ICU length of hospital stay,acute pulmonary edema incidence and mortality,and recovery after 1 month of treatment between the two groups were observed and compared.Result：There was no statistically significant difference in GCS score of the two groups before treatment（P〉0.05）.The GCS score of the study group 1 week after treatment was significantly higher than that of control group,the difference was statistically significant（P〈0.05）.The time of mechanical ventilation and ICU length of hospital stay of the study group were significantly less than those of the control group,and the incidence and mortality of acute pulmonary edema were significantly lower than those of the control group,the differences were statistically significant（P〈0.05）.After 1 month of therapy,the recovery rate of study group was 68.4%,it was significantly higher than the control group（31.6%）,the difference was statistically significant（P〈0.05）.Conclusion：PICCO in fluid management for old patients with severe brain injury can improve prognosis,is worthy of clinical promotion.