[Effects of pulse contour cardiac output monitoring technology in amelioration of myocardial damage in fluid resuscitation of patients with large area burn in the early stage]

Zhonghua Shao Shang Za Zhi. 2019 Aug 20;35(8):574-579. doi: 10.3760/cma.j.issn.1009-2587.2019.08.004.
[Article in Chinese]

Abstract

Objective: To analyze effects of pulse contour cardiac output (PiCCO) monitoring technology in amelioration of myocardial damage in fluid resuscitation of patients with large area burn in the early stage. Methods: From November 2015 to November 2017, medical data of 52 patients with large area burn hospitalized in our unit, meeting the inclusion criteria, were analyzed retrospectively. Twenty-seven patients (18 males and 9 females) with age of (43±10)years in tradition group hospitalized from November 2015 to November 2016 were monitored by traditional monitoring methods for fluid resuscitation, and 25 patients (18 males and 7 females) with age of (44±10)years in PiCCO group hospitalized from December 2016 to November 2017 were monitored by traditional monitoring methods and PiCCO monitoring equipment for fluid resuscitation. Fluid infusion coefficients and total fluid replacement volume of patients in both groups at the first and second post burn hour (PBH) 24, as well as the levels of N terminal pro B type natriuretic peptide (NT-proBNP), cardiac troponin T (cTnT), and creatine kinase MB (CK-MB) immediately on admission and post burn day (PBD) 1, 2, 3, 4, 5, 6, and 7 were recorded. Data were processed with analysis of variance for repeated measurement, chi-square test, t test and Bonferroni correction, and Mann-Whitney U test and Bonferroni correction. Results: (1) The fluid infusion coefficients of patients in tradition group at the first and second PBH 24 were respectively (1.42±0.10) and (0.94±0.14)mL·kg(-1)·% total body surface area (TBSA)(-1), and those in PiCCO group were respectively (1.76±0.14) and (0.85±0.08) mL·kg(-1)·%TBSA(-1). Fluid infusion coefficient and total fluid replacement volume at the first PBH 24 of patients in PiCCO group were significantly higher than those in tradition group (t=-9.775, -4.769, P<0.01). Fluid infusion coefficient at the second PBH 24 of patients in PiCCO group was significantly lower than that in tradition group (t=2.682, P<0.05). There was no statistically significant difference in total fluid replacement volume at the second PBH 24 in patients between the two groups (t=1.167, P>0.05). (2) Immediately on admission and PBD 1, 2, 3, 4, 5, 6, and 7, the levels of NT-proBNP of patients in tradition group were respectively 518 (320, 763), 236 (98, 250), 139 (62, 231), 172 (104, 185), 296 (225, 341), 727 (642, 921), 1 840 (1 357, 2 081), 1 005 (671, 1 297) pg/mL, and those in PiCCO group were respectively 444 (206, 601), 66 (29, 73), 54(28, 75), 139(101, 175), 199 (106, 279), 576 (333, 837), 833 (466, 1 080), 485 (225, 710) pg/mL. The levels of NT-proBNP of patients in PiCCO group on PBD 1, 2, 6, and 7 were significantly lower than those in tradition group (Z=-5.004, -3.967, -5.285, -4.626, P<0.01). The levels of NT-proBNP immediately on admission and PBD 3, 4, and 5 in patients between the two groups were close (Z=-0.834, -0.806, -2.665, -2.153, P>0.05). (3) Immediately on admission and PBD 1, 2, 3, 4, 5, 6, and 7, the levels of cTnT of patients in tradition group were respectively (42±15), (21±12), (17±7), (11±4), (12±4), (94±32), (88±23), (42±23) pg/L, and those in PiCCO group were respectively (37±15), (9±3), (10±3), (13±3), (12±5), (85±30), (60±26), (22±14) pg/L. The levels of cTnT of patients in PiCCO group on PBD 1, 2, 6, and 7 were significantly lower than those in tradition group (t=5.227, 4.751, 4.239, 3.845, P<0.01). The levels of cTnT immediately on admission and PBD 3, 4, and 5 of patients between the two groups were close (t=1.098, -1.562, -0.117, 1.107, P>0.05). (4) The levels of CK-MB of patients in PiCCO group on PBD 3, 6, and 7 were significantly lower than those in tradition group (t=3.123, 4.103, 3.178, P<0.05 or P<0.01). The levels of CK-MB immediately on admission and PBD 1, 2, 4, and 5 in patients between the two groups were close (t=0.351, 1.868, 1.100, 0.798, 2.094, P>0.05). Conclusions: PiCCO monitoring technology can monitor and guide fluid resuscitation of patients with large area burn in the early stage more scientifically and reasonably, and the effect of reducing myocardial damage is better than traditional monitoring methods.

目的: 分析脉搏轮廓心排血量(PiCCO)监测技术应用于大面积烧伤早期补液时改善心肌损害的监测效果。 方法: 回顾性分析笔者单位2015年11月—2017年11月收治的符合入选标准的52例大面积烧伤患者的病历资料,其中2015年11月—2016年11月收治的27例患者以传统方法监测液体复苏[传统组,其中男18例、女9例,(43±10)岁],2016年12月—2017年11月收治的25例患者以笔者单位引进PiCCO监测设备结合传统方法监测液体复苏[PiCCO组,其中男18例、女7例,(44±10)岁]。统计2组患者伤后第1、2个24 h的补液系数和补液总量,入院即刻及伤后1、2、3、4、5、6、7 d的氨基末端脑钠肽前体(NT-proBNP)、心肌肌钙蛋白T(cTnT)及心肌型肌酸激酶同工酶(CK-MB)水平。对数据行重复测量方差分析、χ(2)检验、t检验及Bonferroni校正、Mann-Whitney U检验及Bonferroni校正。 结果: (1)传统组患者伤后第1、2个24 h的补液系数分别为(1.42±0.10)、(0.94±0.14)mL·kg(-1)·%体表总面积(TBSA)(-1),PiCCO组患者第1、2个24 h的补液系数分别为(1.76±0.14)、(0.85±0.08)mL·kg(-1)·%TBSA(-1)。PiCCO组患者伤后第1个24 h补液系数、补液总量均明显高于传统组(t=-9.775、-4.769,P<0.01);PiCCO组患者伤后第2个24 h补液系数明显低于传统组(t=2.682,P<0.05),2组患者伤后第2个24 h补液总量相近(t=1.167,P>0.05)。(2)入院即刻及伤后1、2、3、4、5、6、7 d,传统组患者的NT-proBNP水平分别为518(320,763)、236(98,250)、139(62,231)、172(104,185)、296(225,341)、727(642,921)、1 840(1 357,2 081)、1 005(671,1 297)pg/mL,PiCCO组患者的NT-proBNP水平分别为444(206,601)、66(29,73)、54(28,75)、139(101,175)、199(106,279)、576(333,837)、833(466,1 080)、485(225,710)pg/mL,PiCCO组患者伤后1、2、6、7 d的NT-proBNP水平明显低于传统组(Z=-5.004、-3.967、-5.285、-4.626,P<0.01),2组患者在入院即刻及伤后3、4、5 d的NT-proBNP水平相近(Z=-0.834、-0.806、-2.665、-2.153,P>0.05)。(3)入院即刻及伤后1、2、3、4、5、6、7 d,传统组患者的cTnT水平分别为(42±15)、(21±12)、(17±7)、(11±4)、(12±4)、(94±32)、(88±23)、(42±23)pg/L,PiCCO组患者的cTnT水平分别为(37±15)、(9±3)、(10±3)、(13±3)、(12±5)、(85±30)、(60±26)、(22±14)pg/L。PiCCO组患者伤后1、2、6、7 d的cTnT水平明显低于传统组(t=5.227、4.751、4.239、3.845,P<0.01),2组患者入院即刻及伤后3、4、5 d的cTnT水平相近(t=1.098、-1.562、-0.117、1.107,P>0.05)。(4)PiCCO组患者伤后3、6、7 d的CK-MB水平明显低于传统组(t=3.123、4.103、3.178,P<0.05或P<0.01),2组患者在入院即刻及伤后1、2、4、5 d的CK-MB水平相近(t=0.351、1.868、1.100、0.798、2.094,P>0.05)。 结论: PiCCO监测技术能更科学合理地监测指导大面积烧伤患者的伤后早期补液,减轻心肌损害的效果优于单纯的传统监测方法。.

Keywords: Burns; Myocardial damage; Pulse contour cardiac output; Resuscitation.

MeSH terms

  • Adult
  • Burns / therapy*
  • Cardiac Output*
  • Female
  • Fluid Therapy*
  • Humans
  • Male
  • Middle Aged
  • Myocardium / pathology*
  • Retrospective Studies