对比脉搏指示连续心输出量（PiCCO）与中心静脉压指导扩容对感染性休克合并心肌抑制患者血流动力学的影响。

选择2023年1月至2025年1月期间西安市红会医院收治的感染性休克合并心肌抑制患者84例作为研究对象，采用随机数表法分为观察组及对照组，每组各42例。观察组中男性22例，女性20例；年龄41~62岁[（53.71±4.26）岁]。对照组中男性24例，女性18例；年龄40~64岁[（53.75±4.24）岁]。对照组给予患者中心静脉压指导扩容治疗，观察组给予患者PiCCO治疗。比较两组患者治疗前、治疗24 h、治疗48 h血流动力学[收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、中心静脉压（CVP）]、尿量、液体平衡量水平，比较两组患者治疗前、治疗1周后血气指标[氧合指数（PaO₂/FiO₂）、动脉血二氧化碳分压（PaCO₂）]、急性生理与慢性健康评分（APACHE-Ⅱ）、序贯器官衰竭（SOFA）量表，出院时比较两组患者机械通气时间、住ICU时间，随访28 d病死率。

两组患者的SBP、DBP、MAP、CVP在时间与组别间差异有统计学意义（P<0.05）。治疗24 h、48 h，观察组SBP、DBP均低于对照组，MAP、CVP均高于对照组（P<0.05）；两组患者的尿量、液体平衡量在时间与组别间差异有统计学意义（P<0.05）。治疗24 h、48 h，观察组尿量、液体平衡量均高于对照组（P<0.05）；治疗1周后观察组PaO₂/FiO₂、PaCO₂水平高于对照组（P<0.05）；治疗1周后观察组APACHE-Ⅱ评分及SOFA评分低于对照组（P<0.05）；观察组机械通气时间、住ICU时间短于对照组（P<0.05），28 d病死率少于对照组（P<0.05）。

与中心静脉压指导扩容相比，PiCCO对感染性休克合并心肌抑制中对血流动力改善情况更明显，能提高血气指标，降低病死率。

To explore the comparison of pulse-indicated continuous cardiac output and central venous pressure-guided volume expansion on hemodynamics in patients with septic shock complicated with myocardial depression.

84 patients with septic shock and myocardial depression admitted to Xi'an Red Cross Hospital from January 2023 to January 2025 were selected as the research subjects, with 42 cases in each group. There were 22 males and 20 females in the observation group, aged 41-62 years [(53.71±4.26) years]. The control group consisted of 24 males and 18 females, aged 40-64 years [(53.75±4.24) years]. Patients in the control group received volume resuscitation guided by central venous pressure, while those in the observation group were treated with pulse indicator continuous cardiac output monitoring. The hemodynamics [systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), central venous pressure (CVP)], urine volume and urine balance volume before treatment, 24 hours after treatment and 48 hours after treatment were compared between the two patient groups, the blood gas indicators [oxygenation index (PaO₂/FiO₂), partial pressure of carbon dioxide in arterial blood (PaCO₂)], Acute Physiology and Chronic Health score (APACHE-II), Sequential Organ Failure Assessment (SOFA) scale before treatment and one week after treatment were compared between the two patient groups, at discharge, the mechanical ventilation time, the length of stay in the ICU, and the mortality rate during the 28-day follow-up were compared between the two patient groups.

There was a significant interaction between time and group for SBP, DBP, MAP, and CVP in both patient groups (P<0.05). At 24 h and 48 h after treatment, the observation group exhibited lower SBP and DBP but higher MAP and CVP compared to the control group (P<0.05). Significant interactions were also observed for urine output and fluid balance between time and group (P<0.05). At 24 h and 48 h after treatment, the observation group showed higher urine output and fluid balance than the control group (P<0.05). After one week of treatment, the observation group had higher PaO₂/FiO₂ and PaCO₂ levels than the control group (P<0.05). Additionally, the observation group demonstrated lower APACHE-II and SOFA scores than the control group (P<0.05). The observation group required shorter durations of mechanical ventilation and ICU stays (P<0.05), and had a lower 28-day mortality rate compared to the control group (P<0.05).

Compared with volume expansion guided by central venous pressure, continuous cardiac output indicated by pulse has more obvious improvement on hemodynamics in septic shock complicated with myocardial depression, which can improve blood gas indicators and reduce mortality.