| Purpose:To investigate the effect of the pulse indicator continuous cardiac output monitoring(PiCCO)on patients of septic shock and the effect of early serum biological indicators on the diagnosis and prognosis of septic shock.Methods:A total of 58 septic shock patients who were treated in the department of critical care medicine during January 2014 to December 2016 in Yanbian University Hospital were selected.The patients(48 cases)who was with ICU treatment time more than 24 hours according to whether use the monitoring of PiCCO divided into two groups,the control group(24 cases)and the PiCCO group(24 cases).Furthermore,all the septic shock patients(58 cases)were reassigned into two groups,the survival group(n = 28)and death group(n = 30)according to their prognosis.The informations and a series of indexes of patients in control and PiCCO group were collected,including general information,acute physiology and chronic health evaluation(Acute physiology and chronic health evaluation II,APCHEII score),serum indexes and the residence time in ICU,the percentage of discontinuation of vasoactive drugs for 3 days,the total fluid volume for 3 days treatment,the central venous pressure(CVP).The continuous index of PiCCO group were recorded for the first,the second and the third day.The age,APCHEII score and the levels of 17 serological indexes of patients on admission in the survival group and death group were collected.Results:1.There was no significant difference in age,gender,SBP/DBP and APACHEII score of the patients between the control group and the PiCCO group when hospitalization(P>0.05).2.During the course of treatment,the hemodynamic parameters(CI,GEDI,ELWI,SVRI)values were in the range close to the normal level,under the condition of PiCCO monitoring.After 3 days of treatment,compared with the control group,the total liquid infusion volume of first three days in the PiCCO group patients were numerically reduced,although there was statistical significance.Also the patients in PiCCO group reached the hemodynamic homeostasis more earlier,and had a higher rate of vasoactive drug withdrawal within 72 hours,which have statistical significance(P<0.01);And compared to the control group,the patients in PiCCO group had lower APACHEII scores and shorter ICU residence time after treatment(P<0.05);There was no statistical significance between the two groups in mortality;Furthermore,after three days treatment,the levels of two groups of Lac,IL-6,NGAL,NT-pro BNP,sCysc,sCRP,and PCT of patients in PiCCO group were significantly lower than that in the the control group(P<0.05 or P<0.01),indicating PiCCO group has lower levels of inflammatory mediators and cytokines.3.By comparing 17 indicators such as the APACHEII score,the levels of serum Lac and sCysc in survival group and death group,we analysised the relationship of these parameters with septic shock prognosis.The results showed that the APACHEII score,the levels of serum Lac,sCysc,UA,NGAL,IL-6 were closely related to the prognosis of septic shock patients on admission.Compare to the death group,the patients in survival group had lower APACHEII score and decreased levels of serum Lac,sCysc,UA,NGAL and IL-6,which had statistical significance(P<0.05 or P<0.01).There were no statistical significance of age,CK-MB,NT-pro BNP,Myo,cTnI,PCT,WBC,sCRP,DD,NEUT%,PLT,DBIL,sCr,TBIL and BUN between the two groups(P>0.05).The basic data and biological indexes of 58 cases of patients with septic shock by using Logistic Binary Regression Analysis showed that APACHEII score,IL-6,NGAL,Lac,sCysc,UA and NGAL were the factors related to death of septic shock(P<0.05).4.The relationship between CK-MB,NT-pro BNP and other 17 cytokines,inflammatory mediators and septic shock(58 cases)were retrospectively analyzed by using the ROC curve.The results showed that the levels of IL-6 and NGAL had early predictive value in septic shock diagnosis,and levels of sCysc,CK-MB,UA followed them.Conclusion:1.PiCCO monitoring guidance is benefit for the septic shock patients achieving early hemodynamic stability;It also reduces the inflammatory response,decreases APACHE II score,and ultimately shortens ICU retention time of patients with septic shock.2.IL-6,NGAL,sCysc,CK-MB and UA have the predictive value of early diagnosis of septic shock,and IL-6 have more valuable and NGAL have higher sensitivity and specificity in septic shock early diagnosis.3.The APACHEII score,levels of serum Lac,sCysc,UA,NGAL,IL-6 were correlated with prognosis of patients with septic shock,and NGAL may be a new biomarker for predicting the prognosis of septic shock. |
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