Application Of Non-invasive Cardiac Output Monitoring In Early Fluid Resuscitation Of Shock Caused By Acute Severe Pancreatitis

Objective:To explore the application value of noninvasive cardiac output monitoring(NICOM)in the treatment of severe acute pancreatitis(SAP)with early fluid resuscitation.Methods:he patients with shock caused by acute severe pancreatitis who were admitted to the Department of Emergency Medicine of our hospital from June 2019 to October 2020 were collected as the research objects.According to the random number table method,they were divided into the experimental group and the control group;the experimental group was in the implementation of early liquid During resuscitation,non-invasive cardiac output was used to monitor hemodynamics,and the rate of rehydration and the application dose of vasoactive drugs were adjusted according to the dynamic changes of related indicators.The control group was monitored by non-invasive cuff heart rate,blood pressure,and oxygen monitor in early fluid resuscitation treatment.Compare the duration of fluid resuscitation treatment and the amount of fluid per kilogram of body weight in the two groups of patients,and blood creatinine and oxygenation index indicators and changes,calculate the APACHE Ⅱ score,PCT and CRP levels before and after fluid resuscitation treatment,record and compare the mechanical ventilation of the two groups of patients within 48 hours for statistics.Results:During the study period,a total of 80 patients in the emergency department of our hospital who met the diagnostic criteria for acute severe pancreatitis in the"According to Atlanta Classification Standards" and were in shock were enrolled.The two groups of patients before resuscitation were classified in terms of gender and age.,Body mass index(BMI),mean arterial pressure,heart rate,urine output and other general conditions were not statistically significant(P>0.05),blood routine,blood gas analysis,blood biochemistry and other indicators were not statistically significant(P>0.05);After statistical analysis of recorded indicators before and after fluid resuscitation treatment,the duration of fluid resuscitation treatment in the experimental group was lower than that of the control group(14.54± 1.62 vs 19.37±1.66,t=5.173,P<0.05).There was no significant difference in fluid volume compared with the control group(6.24±2.74 vs 6.52±2.11,t=0.323,P>0.05);before treatment,there was no significant difference in APACHE Ⅱ score between the two groups(24.9±5.3 vs 24.3±5.7,t=0.408,P>0.05).After treatment,the score of the experimental group was lower than that of the control group(12.3±3.4 vs 16.4±3.5,t=5.314,P<0.05),and the improvement rate of the experimental group was higher than that of the control group(51.0±4.2%vs 34.4)± 1.8%,t=22.976,P<0.05);before treatment,CRP levels(79.86± 14.57 vs 81.32± 1.66,t=0.498,P>0.05)and PCT levels(20.97± 12.66 vs 21.28±9.53,t=0.124,P>0.05),there was no significant difference.After treatment,the PCT level of the experimental group(8.13±3.74 vs 10.67±4.02,t=2.926,P<0.05),CRP level(14.54± 1.62 vs 19.37± 1.66,t=2.973,P<0.05)were lower than the control group,PCT(61.3±6.5%vs 44.9±2.4%,t=14.79,P<0.05)and CRP improvement rate(81.4±7.1 vs 78.1 ±5.6,t=2.308,P<0.05)The test group was higher than the control group;before treatment,the two groups had no significant difference in serum creatinine(149.6± 12.2 vs 151.1 ± 11.9,t=0.557,P>0.05)and oxygenation index(176.6±22.8 vs 173.5±23.3,t=1.323,P>0.05).After treatment,the blood creatinine level of the experimental group was lower than that of the control group(103.6±8.6 vs 128.6±9.2,t=12.555,P<0.05),and the oxygenation index was higher than that of the control group(253.6 ± 25.2 vs 214.6 ± 26.8,t=15.021,P<0.05),the improvement rate of serum creatinine in the test group was higher than that in the control group(30.8± 1.6 vs 15.2±2.3,t=34.083,P<0.05),the oxygenation index improvement rate of the experimental group was higher than that of the control group(43.8±5.2 vs 19.2±3.1,t=25.700,P<0.05);48h of resuscitation There was no significant difference in the use of endotracheal intubation mechanical ventilation between the experimental group and the control group(χ2=2.581,P>0.05)..Conclusions:In the early fluid resuscitation treatment of shock caused by severe pancreatitis,non-invasive cardiac output monitoring can effectively shorten the time of fluid resuscitation,relieve acute inflammation,reduce the damage of distal organs in the early stage of shock,and improve the prognosis of patients.