中心静脉压对感染性休克患者的病情判定与分层次护理

目的 探讨中心静脉压(central venous pressure，CVP)对感染性休克患者的病情判定价值与分层次护理措施。方法 2012年9月到2017年8月选择在我院急诊ICU收治的感染性休克患者86例，所有患者都给予CVP指导临床液体复苏策略，对照组给予常规护理，观察组给予分层次护理，记录两组的CVP变化情况与预后情况。结果 两组患者复苏6h的APACHE Ⅱ评分低于护理前(P<0.05)，护理后观察组评分低于对照组(P<0.05)。两组患者复苏后不同时间点的CVP都高于复苏前(P<0.05)，复苏6h的CVP也高于复苏3h(P<0.05)，且观察组也高于对照组(P<0.05)。观察组的去甲肾上腺素、多巴酚丁胺等血管活性药物使用剂量都少于对照组(P<0.05)。观察组的机械通气时间、ICU入院时间少于对照组，液体平衡量多于对照组，对比差异有统计学意义(P<0.05)。观察组的满意度为100.0%，显著高于对照组的87.5%(〖XC小五号.EPS;P〗=6.105，P=0.013)。结论 CVP在感染性休克复苏治疗中是一项可行的病情判定与监测指标，分层次护理的应用能减少患者血管活性药物的使用，调节CVP水平，促进降低APACHE Ⅱ评分，改善患者的预后，且有利于提高患者的满意度。

Diagnosis and hierarchical nursing of patients with septic shock by central venous pressure

Objective To investigate the values of central venous pressure(CVP) in determining the condition of patients with septic shock and the hierarchical nursing ways. Methods From September 2012 to August 2017, 86 cases of septic shock patients in emergency ICU of our hospital were selected as the research object, all patients were given CVP clinical resuscitation strategy. The control group were given conventional nursing, while the observation group were received the hierarchical nursing, two group of CVP changes and prognosis were recorded. Results The APACHE Ⅱ score of the two groups of patients after 6 hours of resuscitation was lower than before nursing(P <0.05), and the observation group after nursing was lower than the control group(P <0.05).The CVP in two groups of patients at different time points after resuscitation were higher than that before resuscitation(P<0.05). The CVP of resuscitation 6 h were also higher than that of resuscitation 3 h(P<0.05), and the observation group were also higher than that of the control group(P<0.05). The dose of norepinephrine and dobutamine and other vasoactive drugs in the observation group was less than that of the control group(P<0.05). The mechanical ventilation time and ICU admission time in the observation group were less than those in the control group, and the fluid balance in the observation group were more than that in the control group, there were difference compared between the two groups(P<0.05). The degree of satisfaction of the observation group and the control group were 100% and 87.5% respectively, and the observation group were higher than the control group(X2=6.105, P=0.013). Conclusion CVP in septic shock resuscitation is a feasible condition judging and monitoring indicators, application of hierarchical nursing can reduce the use of vasoactive drugs in patients, regulate the level of CVP, promote the reduction of APACHE Ⅱ score, improve the prognosis of patients, and improve the patients’ satisfaction.