Value of early hemodynamic monitoring in patients complicated with septic shock after holmium laser lithotripsy of urinary system

Abstract:

Objective：To explore the value of early hemodynamic monitoring in patients complicated with septic shock patients after holmium laser lithotripsy of urinary system. Methods：Clinical data of 37 patients with septic shock after holmium laser lithotripsy of urinary tract who were admitted to our department of The First Affiliated Hospital of Chongqing Medical University from January 2013 to December 2018 were retrospectively analyzed. According to the liquid resuscitation under pulse index continuous cardiac output（PiCCO），those patients were divided into the PiCCO monitoring group and the non-PiCCO monitoring group. General informa－tion，pre-treatment indicators of disease severity，pre-and-post-treatment PiCCO monitoring indicators and clinical indicators after treatment of 6h and 24 h in two groups were respectively ana－lyzed. Results：After treatment of 6h，global end diastolic volume index（GEDI），cardiac index（CI），external lung water index（EVLWI），systemic vascular resistance index（SVRI） and mean arterial pressure（MAP） in the PiCCO monitoring group were increased when compared with those before treatment（Z：-3.393，-4.059，-4.189，-3.241，-3.736；P：0.005，0.000，0.000，0.001，0.000）；after treatment of 24 h，GEDI，CI and SVRI were higher than those after treatment of 6 h（Z：-3.751，-2.738，-4.749；P：0.000，0.006，0.000）. After treatment of 6 h，levels of blood lactic acid and norepinephrine in the PiCCO monitoring group were lower than those in the PiCCO monitoring group（Z：-2.070，-3.895；P：0.038，0.000）；after treatment of 6 h and 24 h，oxygenation index（PO2/FiO2） and urine volume per hour in the PiCCO mon－itoring group were higher than those in the non-PiCCO monitoring group（Z after treatment of 6 h：-2.499，-3.314；P：0.012，0.001；Z after treatment of 24 h：-3.833，-3.466；P：0.000，0.001）；after treatment of 6 h，the total amount of crystalline liquid and colloidal fluid in the PiCCO monitoring group were increased when compared with those in the non-PiCCO monitoring group（Z：-4.845，-4.401；P：0.000，0.000）；after treatment of 24 h，the total amount of crystalline liquid and colloidal fluid in the PiCCO monitoring group were decreased when compared with those in the non-PiCCO monitoring group（Z：-2.338，-2.948；P：0.019，0.003）. After treat－ment，the duration of mechanical ventilation and ICU stay in the PiCCO monitoring group were lower than those in the non-PiCCO monitoring group（Z：-2.195，-2.173；P：0.028，0.030）. Early fluid resuscitation，dosage adjustment of vasoactive drugs，maintenance of circulation stability，improvement of tissue perfusion and reduction of complications in the PiCCO monitoring group were superior than those in the non-PiCCO monitoring group. Conclusion：Comprehensive treatment centered with precise fluid resuscitation under the guidance of PiCCO monitoring plays an important role in alleviating illness，reducing complications caused by excessive fluid resuscitation and shortening time for mechanical ventilation and ICU treatment，which may be used as a new clinical treatment strategy for patients complicated with septic shock after holmium laser lithotripsy of ureteral calculi.