Effect of application of pulse contour cardiac output monitoring technology on delayed resuscitation of patients with extensive burn in a mass casualty
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摘要: 目的 探讨脉搏轮廓心排血量(PiCCO)监测技术在成批特大面积烧伤患者延迟复苏中的应用效果。 方法 对2014年8月苏州大学附属第一医院、解放军第一〇〇医院及苏州市立医院收治的昆山爆炸事故中41例特大面积烧伤患者的临床资料进行回顾性分析。根据患者延迟复苏的监测方法分为传统监测组22例和PiCCO监测组19例。统计2组患者入院后2 h内,伤后第1、2、3个8 h及第1个24 h电解质、胶体、水输入量。计算2组患者入院后2 h内,伤后第1、2、3个8 h及伤后第1、2、3、4个24 h的补液系数。统计2组患者伤后8、16、24、48、72、96 h的尿量、平均动脉压(MAP)、中心静脉压(CVP),伤后24、48、72、96 h的血乳酸、剩余碱、血细胞比容(HCT)及血小板计数。统计2组患者的并发症及死亡情况。对数据行重复测量方差分析、
χ 2检验、t 检验、Wilcoxon检验。计算2组41例患者伤后第1个24 h补液系数和2的差值与伤后第2个24 h补液系数和2的差值,伤后第3、4个24 h补液系数和1的差值与伤后第2个24 h补液系数和1的差值,对这3组差值行Pearson相关分析。 结果 (1)伤后第1个8 h及第1个24 h,PiCCO监测组患者电解质输入量明显多于传统监测组(Z 值分别为-3.506、-2.654,P <0.05或P <0.01),余时间段2组患者电解质输入量相近(Z 值为-1.871~-0.680,P 值均大于0.05)。伤后第2、3个8 h及第1个24 h,PiCCO监测组患者胶体输入量明显少于传统监测组(Z 值为-4.720~-2.643,P <0.05或P <0.01),余时间段2组患者胶体输入量相近(Z 值分别为-2.376、-2.303,P 值均大于0.05)。各时间段2组患者水输入量相近(Z 值为-1.959~-0.241,P 值均大于0.05)。(2)入院后2 h内与伤后第1、2、3个8 h及伤后第1、2、3、4个24 h,传统监测组患者的补液系数分别为(0.59±0.18)、(0.70±0.23)、(0.94±0.24)、(0.74±0.14)、(2.38±0.44)、(1.70±0.56)、(1.35±0.67)、(0.92±0.46)mL·kg-1·%TBSA-1,PiCCO监测组患者的补液系数分别为(0.59±0.29)、(0.82±0.37)、(0.86±0.38)、(0.59±0.24)、(2.27±0.85)、(2.13±0.68)、(1.59±3.78)、(1.46±0.56)mL·kg-1·%TBSA-1。入院后2 h内与伤后第1、2个8 h及伤后第1、3个24 h, 2组患者补液系数相近(t 值为-1.262~0.871,P 值均大于0.05);伤后第3个8 h,PiCCO监测组患者补液系数明显低于传统监测组(t =2.456,P <0.05);伤后第2、4个24 h,PiCCO监测组患者补液系数明显高于传统监测组(t 值分别为-2.234、-3.370,P <0.05或P <0.01)。2组患者伤后第1个24 h补液系数和2的差值与伤后第2个24 h补液系数和2的差值呈明显负相关(r =-0.438,P <0.01);伤后第2个24 h补液系数和1的差值与伤后第3个24 h补液系数和1的差值无明显相关性(r =0.091,P >0.05);伤后第2个24 h补液系数和1的差值与伤后第4个24 h补液系数和1的差值呈明显正相关(r =0.695,P <0.01)。(3)2组患者伤后各时相点尿量及MAP相近(Z 值为-1.884~0,P 值均大于0.05)。伤后16、24、48、72 h,PiCCO监测组患者CVP明显高于传统监测组(Z 值为-4.341~-2.213,P <0.05或P <0.01),余时相点2组患者CVP相近(Z 值分别为-0.132、-1.208,P 值均大于0.05)。伤后72 h,PiCCO监测组患者血乳酸明显高于传统监测组(Z =-2.958,P <0.01),余时相点2组患者血乳酸相近(Z 值为-1.742~-0.433,P 值均大于0.05)。伤后24、48、72、96 h,PiCCO监测组患者剩余碱明显低于传统监测组(Z 值为-4.970~-4.734,P 值均小于0.01)。伤后24、48、72、96 h,2组患者HCT相近(Z 值为-2.239~-0.196,P 值均大于0.05)。伤后24、72、96 h,PiCCO监测组患者血小板计数与传统监测组比较,差异有统计学意义(Z 值为-4.578~-2.512,P <0.05或P <0.01)。(4)传统监测组伴并发症者15例,死亡7例;PiCCO监测组伴并发症者13例,死亡9例。2组患者的并发症发生情况及死亡情况相近(χ 2值分别为<0.001、1.306,P 值均大于0.05)。 结论 在传统烧伤休克监测指标的基础上,以PiCCO监测技术指导特大面积烧伤患者进行液体复苏的效果欠佳,仍需进一步临床研究。-
关键词:
- 烧伤 /
- 电解质 /
- 复苏术 /
- 脉搏轮廓心排血量监测技术
Abstract: Objective To investigate the effect of the application of pulse contour cardiac output (PiCCO) monitoring technology on delayed resuscitation of patients with extensive burn in a mass casualty. Methods The clinical data of 41 patients injured in Kunshan dash explosion hospitalized in the First Affiliated Hospital of Soochow University, the 100th Hospital of the People's Liberation Army, and Suzhou Municipal Hospital were retrospectively analyzed. The patients were divided into traditional monitoring group (T,n =22) and PiCCO monitoring group (P,n =19) according to the monitoring technic during delayed resuscitation. The input volumes of electrolyte, colloids, and water of patients in the two groups within 2 hours after admission, the first, second, and third 8 hours post injury (HPI), and the first 24 HPI were recorded. The fluid infusion coefficients of patients in the two groups within 2 hours after admission, the first, second, and third 8 HPI, and the first, second, third, and fourth 24 HPI were calculated. The urine volume, mean arterial pressure (MAP), and central venous pressure (CVP) of patients in the two groups at post injury hour (PIH) 8, 16, 24, 48, 72, and 96 were recorded. The blood lactate, base excess, hematocrit (HCT), and platelet count of patients in the two groups at PIH 24, 48, 72, and 96 were recorded. Complications and death of patients in the two groups were recorded. Data were processed with analysis of variance for repeated measurement, Chi-square test,t test, and Wilcoxon test. The deviations between figure 2 and the fluid infusion coefficients of the first or second 24 HPI, and the deviations between figure 1 and the fluid infusion coefficients of the second, third or fourth 24 HPI were calculated, and the three groups deviations were analyzed by Pearson correlation analysis. Results (1) The input volumes of electrolyte of patients in group P were significantly more than those in group T within the first 8 and 24 HPI (withZ values respectively -3.506 and -2.654,P <0.05 orP <0.01), and the input volumes of electrolyte of patients in the two groups were similar within the other time periods (withZ values from -1.871 to -0.680,P values above 0.05). The input volumes of colloid of patients in group P were significantly less than those in group T within the second, third 8 HPI, and the first 24 HPI (withZ values from -4.720 to -2.643,P <0.05 orP <0.01), and the input volumes of colloid of patients in the two groups were similar within the other time periods (withZ values respectively -2.376 and -2.303,P values above 0.05). The input volumes of water of patients in the two groups were similar within each time period (withZ values from -1.959 to -0.241,P values above 0.05). (2) The fluid infusion coefficients of patients in group T within 2 hours after admission, the first, second, and third 8 HPI, and the first, second, third, and fourth 24 HPI were respectively (0.59±0.18), (0.70±0.23), (0.94±0.24), (0.74±0.14), (2.38±0.44), (1.70±0.56), (1.35±0.67), and (0.92±0.46) mL·kg-1·%TBSA-1, and the values in group P were respectively (0.59±0.29), (0.82±0.37), (0.86±0.38), (0.59±0.24), (2.27±0.85), (2.13±0.68), (1.59±3.78), and (1.46±0.56) mL·kg-1·%TBSA-1. The fluid infusion coefficients of patients in the two groups were similar within 2 hours after admission, the first, second 8 HPI, and the first, third 24 HPI (witht values from -1.262 to 0.871,P values above 0.05). The fluid infusion coefficient of patients in group P was significantly lower than that in group T within the third 8 HPI (t =2.456,P <0.05), and the fluid infusion coefficient of patients in group P were significantly higher than that in group T within the second and fourth 24 HPI (witht values respectively -2.234 and -3.370,P <0.05 orP <0.01). There was obviously negative correlation between the deviations of figure 2 and the fluid infusion coefficient of the first 24 HPI and that of the second 24 HPI (r =-0.438,P <0.01). There was no obvious correlation between the deviations of figure 1 and the fluid infusion coefficient of the second 24 HPI and that of the third 24 HPI (r =0.091,P >0.05). There was obviously positive correlation between the deviations of figure 1 and the fluid infusion coefficient of the second 24 HPI and that of the fourth 24 HPI (r =0.695,P <0.01). (3) The urine volumes and MAP of patients in the two groups were similar at each time point (withZ values from -1.884 to 0,P values above 0.05). The CVP of patients in group P were significantly higher than that in group T at PIH 16, 24, 48, and 72 (withZ values from -4.341 to -2.213,P <0.05 orP <0.01), and the CVP of patients in the two groups were similar at the other time points (withZ values respectively -0.132 and -1.208,P values above 0.05). The blood lactate of patients in group P was significantly higher than that in group T at PIH 72 (Z = -2.958,P <0.01) , and the blood lactate of patients in the two groups were similar at the other time points (withZ values from -1.742 to -0.433,P values above 0.05). The base excess of patients in group P were significantly lower than that in group T at PIH 24, 48, 72, and 96 (withZ values from -4.970 to -4.734,P values below 0.01). The HCT of patients in the two groups were similar at PIH 24, 48, 72, and 96 (withZ values from -2.239 to -0.196,P values above 0.05). There were significant differences in the platelet count of patients in the two groups at PIH 24, 72, and 96 (withZ values from -4.578 to -2.512,P <0.05 orP <0.01). (4) There were 15 cases in group T accompanied by complications, and 7 cases died, while 13 cases in group P accompanied by complications, and 9 cases died. The occurrence of complications and death of patients in the two groups were similar (withχ 2 values respectively <0.001 and 1.306,P values above 0.05). Conclusions On the basis of traditional burn shock monitoring index, the effect of fluid resuscitation in patients with severe burn monitored by PiCCO technology is not so good and still needs further clinical research.-
Key words:
- Burns /
- Electrolytes /
- Resuscitation /
- Pulse contour cardiac output monitoring technology
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