PICCO在重症急性胰腺炎早期液体复苏中的应用

目的：探讨重症急性胰腺炎的休克患者脉搏指数连续心输出量（PICCO）监测在早期液体复苏中的作用。方法：对30例伴有重症急性胰腺炎的休克患者的临床资料进行回顾性分析，根据预后分为存活组15例、死亡组15例，比较PICCO连续监测记录每例置管期间的血流动力学参数，记录每例置管期间每日液体平衡（W），分析PICCO监测的血流动力学特点及影响患者预后的危险因素。结果：两组置管时血流动力学类型多为低排高阻型、血管外肺水指数（EVLWI）高，置管期间每日液体平衡的量（W）与血管外肺水指数的变化值（△EVLWI）及全心舒张末期容积指数的变化（AOEDI）相关性显著。两组置管第3天死亡组的EVLWI明显高于生存组的EVLWI，差异具有统计学意义（P〈0．01）。结论：对于伴有重症急性胰腺炎的休克病人，PICCO监测的全心舒张末期容积指数（GEDI）较中心静脉压（CVP）更适合反映伴有重症急性胰腺炎的休克患者的容量状态，EvLwI的动态变化可以作为伴有重症急性胰腺炎休克患者预后的独立预测指标，对指导临床复舒、增强复苏效果起到的重要作用，值得推广应用。

Application of PICCO for early liquid recovery of patients with severe acute pancreatitis

Objective To investigate the application of shock pulse index of continuous cardiac output （PICCO） in monitoring of patients with severe acute pancreatitis during early liquid recovery. Methods： Data of 30 cases with severe acute pancreatitis patients complicated with shock were retrospectively analyzed. These patients were divided into survival group （15 cases）, and death group （15 cases）, comparison of hemodynamic parameters according to PICCO continuous monitoring records, daily fluid balance （W） during catheter period were conducted. Hemodynamic characteristics of PICCO monitor and risk factors affecting prognosis of patients were analyzed. Results In both groups, the main hemodynamic types were low exhaust and high resistance, lung water index （EVLWI） outside blood vessels is high. Daily liquid equilibrium quantity （W） and vascular chan- ges of lung water index value （delta EVLWI）, changes of the whole heart end diastolic volume index （delta GEDI） were significantly related with each other. On the third day of catheter, EVLWI of the death group was obviously higher than that of sur vival group （P〈0.01）. Conclusion For shock patients with severe acute pancreatitis, PICCO monitor is better than central venous pressure （CVP） in monitoring end-diastolic volume index （GEDI）, and dynamic changes of EVLWI can be used as in- dependent indicator {or predicting prognosis of patients with severe acute pancreatitis.