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Objective To compare the early fluid resuscitation effect of transpulmonary thermodilution (PICCO) monitoring combined with the passive leg raising (PLR) test and central venous pressure(CVP) mo-nitoring in severe sepsis .Methods Sixty patients with severe sepsis admitted in this hospital from January to December 2016 were selected and divided into the treatment group (n=28) and control group(n=32) accord-ing to the random number table method .The treatment group adopted PICCO monitoring combined with PLR ,while the control group adopted CVP monitoring .The changes of plasma natriuretic peptide (BNP) and blood lactic acid(LAC) levels at 6 ,24 ,48 ,72 h in two groups ,time of vasoactive drugs withdrawn ,mechanical ventilation time ,ICU stay length ,and occurrence situation of multiple organ dysfunction syndrome (MODS) and death were compared between the two groups .Results The plasma BNP levels at 24 ,48 ,72 h in the treat-ment group were lower than those in the control group at the same period ,the difference was statistically sig-nificant(P<0 .05);The plasma LAC levels at 24 ,48 ,72 h in the treatment group were lower than those in the control group at the same periods ,the difference was statistically significant (P<0 .05);The vasoactive drug withdrawal time in the treatment group was faster than that in the control group ,the mechanical ventilation time was shorter than that in the control group ,and the ICU stay time was shorter than that in the control group ,the difference was statistically significant (P<0 .05);The occurrence rates of MODS and death had no statistical difference between the two groups (P>0 .05) .Conclusion The PICCO monitoring combined with PLR in severe sepsis has better early fluid resuscitation curative effect than the CVP monitoring and has im-portant study significance .
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Objective To investigate the use of PLR induced VTI changes combined with P(cv-a)CO2 in sepsis shock early fluid resuscitation. Methods 54 patients with sepsis shock admitted in Chancheng district central hospital from March 2016 to May 2017 were randomly divided into the treatment group (n=26) and the control group (n=28). The treatment group were monitored by the PLR induced VTI changes combined with P(cv-a)CO2, while the control group were monitored by CVP. The changes of 6 h, 12 h, 24 h, CVP, BNP and LAC levels, the time of vasoactive drugs, the time of mechanical ventilation, ICU hospitalization time and mortality were compared between the two groups. Results There were no statistic difference in fluid infusion within 6h, CVP, BNP, and LAC levels in the two groups; Fluid infusion within 12 h and 24 h, CVP and BNP in the treatment group were lower than those in the control group (P<0.05); the two groups for the treatment of 12 h,24 h plasma, LAC levels were no significant difference; The application time of vasoactive drugs, the time of mechanical ventilation and the length of hospitalization in ICU in the treatment group were shorter than those in the control group (P<0.05); The 28 day mortality was not statistically different between the two groups. Conclusion PLR induced VTI changes combined with P (cv-a) CO2 in septic shock early fluid resuscitation monitoring is superior to CVP, which has the important research significance.
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OBJECTIVE:To compare the sedative effects of dexmedetomidine and midazolam in patients with comprehensive ICU mechanical ventilation. METHODS:74 patients in ICU were randomly divided into dexmedetomidine group (37 cases) and midazolam group (37 cases). Based on mechanical ventilation,dexmedetomidine group received 200 μg Dexmedetomidine injec-tion,dissolving in 48 ml 0.9% Sodium chloride injection,pumped by 1 μg/kg within 30 min,then adjusted to 0.2-0.7 μg/(kg·h) by micropump. Midazolam group received 30 mg Midazolam injection,dissolving in 44 ml 0.9% Sodium chloride injection, pumped by 0.05 mg/kg within 15 min,then adjusted to 0.04-0.20 mg/(kg·h)by micropump. The sedative effects,clinical indica-tors(weaning time,extubation time,time of mechanical ventilation,ICU hospitalization time)and the incidence of adverse reac-tions in 2 groups were observed. RESULTS:There was no significant difference in the sedative effects(P>0.05);weaning time, extubation time,and ICU hospitalization time in dexmedetomidine group were significantly shorter than midazolam group,the dif-ferences were statistically significant(P<0.05);the incidence of total adverse reactions in dexmedetomidine group was significant-ly lower than midazolam group,the difference was statistically significant (P<0.05). CONCLUSIONS:Dexmedetomidine show similar sedative effects with midazolam in patients with comprehensive ICU mechanical ventilation,shorter weaning time,extuba-tion time,ICU hospitalization time,and lower incidence of total adverse reactions than midazolam.