Clinical Study On PiCCO Monitoring In Guidance Of Early Goal-directed Fluid Therapy In Patients With Septic Shock

Objective: To observe the application value of Pulse indicator continuous cardiac output(PiCCO)monitoring in guidance of Early goal-directed fluid therapy(EGDT)in patients with septic shock.Methods: 60 cases patients with septic shock in Intensive care unit(ICU)of the second affiliated hospital of Ningxia Medical university from September 2015 to July2017 were selected.All patients were randomly divided into two groups: PiCCO group(30 cases)received PiCCO monitoring to guide EGDT,traditional group(30cases)received Central venous pressure(CVP)monitoring to guide EGDT.Sequential organ failure assessment(SOFA)scores and Acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)scores,CVP,Mean arterial pressure(MAP),Blood lactic acid(LAC)before treatment of all patients were recorded.CVP,MAP,LAC,urine volume per hour,vascular active drug dosage,amount of fluid resuscitation at 6 h,24 h,72 h after the treatment of patients in the two groups were observed.Compared prognostic indicators(duration of mechanical ventilation,ICU stay time,6 h fluid resuscitation standard rate,28-day case fatality rate)of patients in the two groups.Record PiCCO monitoring parameters at the four time points before and after treatment of patients in PiCCO group.Results:(1)There were no significant differences in age,sex ratio,SOFA scores,APACHE Ⅱ scores,CVP,MAP,LAC before treatment of patients in the two groups(P > 0.05).(2)CVP,MAP,urine volume per hour,amount of fluid resuscitation at 6 h,24 h after the treatment of patients in PiCCO group were obviously higher thantraditional group(P < 0.05);LAC at 6 h,24 h after the treatment of patients in PiCCO group was obviously lower than traditional group(P < 0.05);vascular active drug dosage(norepinephrine)at 6 h,24 h,72 h after the treatment of patients in PiCCO group was obviously lower than traditional group(P < 0.05).(3)In comparison to traditional group,PiCCO group showed obviously shorter in duration of mechanical ventilation and ICU stay time(P < 0.05);6 h fluid resuscitation standard rate of patients in PiCCO group was obviously higher than traditional group(P < 0.05);there was no significant differences in 28-day case fatality rate of patients in the two groups(P > 0.05).(4)Compared with that before treatment,Cardiac output index(CI),Intrathoracic blood volume index(ITBVI),Global end diastolic volume index(GEDVI)at 6 h,24 h,72 h after the treatment of patients in PiCCO group were significantly increasing(P < 0.05)while Stroke volume variation(SVV)at 6 h,24 h,72 h after the treatment was significantly decreasing(P < 0.05);SVV at 72 h after the treatment was obviously smaller than that at 6 h after the treatment(P < 0.05);compared with that before the treatment,Systemic vascular resistance index(SVRI)at72 h after the treatment was significantly increasing(P < 0.05).Extravascular lung water index(EVLWI)had no significant change before and after treatment(P > 0.05).Conclusion: PiCCO monitoring guiding EGDT in patients with septic shock can obviously improve hemodynamic status,increase 6 h fluid resuscitation standard rate while does not increase lung water,reduces duration of mechanical ventilation and ICU stay time,but it has no obvious effect on long-term case fatality rate of patients.