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脉搏指示连续心输出量在动脉瘤蛛网膜下腔出血后早期并发肺水肿中的应用
吴娅秋,曾义,刘蓉安,兰蕴平,梁宗安
0
(四川省医学科学院·四川省人民医院神经外科ICU;四川省医学科学院·四川省人民医院外科ICU;四川大学华西医院呼吸与危重症医学科)
摘要:
【摘要】 目的 探讨脉搏指示连续心输出量(PiCCO)在动脉瘤性蛛网膜下腔出血(aSAH)后早期并发肺水肿(PE)中的应用研究。方法 研究2015年1月~2017年1月四川省人民医院神经外科ICU病房诊断明确aSAH发生48 h内并行开颅夹闭或血管内介入栓塞术后患者,根据纳入及排除标准,家属签署知情同意书后,入组80例患者按照随机数字表分为常规治疗组和PiCCO监测组,每组40例。比较两组患者aSAH后早期PE、迟发性脑缺血(DCI)发生率、入组第1~7 d每日液体总入量、ICU住院时间、总住院时间。所有入组患者均随访6个月后根据神经功能状态改良Rankin评分(MRS)分为PE组(并发PE患者)和非PE组(未并发PE患者),比较6个月后PE组和非PE组患者MRS评分。结果两组年龄、性别、动脉瘤部位、手术方式、HuntHess分级、WFNS分级比较差异无统计学意义(均P>0.05)。与常规治疗组相比,PiCCO监测组PE发病率显著降低(P<0.05);入组后第1~7 d 每日液体总入量均显著减少(P<0.05);ICU住院时间、总住院时间更短(均P<0.05)。两组DCI发病率比较差异无统计学意义(P>0.05)。非PE组和PE组神经功能状态MRS评分情况比较差异有统计学意义(P<0.05)。结论 PiCCO监测与指导可显著降低aSAH后早期并发PE的发生率、减少液体入量、缩短ICU住院时间及总住院时间,显著改善6个月后MRS神经功能状态评分,早期并发PE患者临床预后显著降低。
关键词:  动脉瘤性蛛网膜下腔出血  肺水肿  连续心输出量监测  迟发性脑缺血  MRS评分
DOI:
基金项目:
Application of PiCCO in early pulmonary edema after aneurysmal subarachnoid hemorrhage
WU Yaqiu,ZENG Yi,LIU Rongan,LAN Yunping,LIANG Zongan
(Department of Neurosurgery ICU, Sichuan Academy of Medical Sciences & Sichuan Provincial People′s Hospital;Department of Surgery ICU, Sichuan Academy of Medical Sciences & Sichuan Provincial People′s Hospital;Department of Respiratory and Critical Care Medicine, West China Hospital)
Abstract:
【Abstract】 Objective To understand the general situation of early pulmonary edema (PE) after aneurysm subarachnoid hemorrhage (aSAH) by using continuous pulse indicator continuous cardiac output (PiCCO) and observe the blood volume change of patients at early stage after aSAH. Methods From January 2015 to January 2017, the patients in the Neurosurgery ICU ward of Sichuan people's Hospital determined that within 48 hours after the occurrence of aSAH, undergone craniotomy, clipping or intravascular interventional embolization were included in the study. According to the inclusion and exclusion criteria, after the family members signed the informed consent, 80 patients in the study group were divided into the conventional treatment group and the PiCCO monitoring group according to the attached digital table, 40 in each group. The early PE, delayed cerebral ischemia (DCI), daily liquid intake, ICU hospitalization time and total hospitalization time were compared between the two groups. All the patients were followed up for 6 months and were divided into PE group (patients with PE) and non PE group (patients without PE) according to the improved Rankin score (MRS) of neurological function. The MRS scores of PE group and non PE group were compared after 6 months. Results There was no significant difference between the two groups in age, gender, aneurysm location, operation mode, hunt Hess and WFNS (P>0.05). Compared with the routine group, the incidence of PE in PiCCO monitoring and treatment group was significantly lower (P<0.05). The daily total liquid intake decreased significantly (P<0.05), and the length of stay in ICU was shorter (P<0.05). There was no significant difference in the incidence of DCI between the two groups (P>0.05). There was a significant difference in Mrs scores between non PE group and PE group (P<0.05). Conclusion PiCCO monitoring and guidance can significantly reduce the incidence of PE in early stage after aSAH, reduce the amount of liquid, shorten the length of stay in ICU and the total length of stay, significantly improve the score of Mrs neurological status after 6 months, and significantly reduce the prognosis of PE patients in early stage.
Key words:  Aneurysm subarachnoid hemorrhage  Pulmonary edema  Pulse indicator continuous cardiac output  Delayed cerebral ischemia  MRS score

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