心肺容積監視器於敗血性休克病人的臨床應用

The Clinical Application of Pulse-induced Contour Cardiac Output (PiCCO) in Septic Shock Patients

敗血性休克為加護病房中常見問題，死亡率相當高。心肺容積監視器自1990年代晚期問世以來，被用在多種不同病人的血液動力監測上，尤其是敗血性休克的病人。因有關心肺容積監視器的中文資料不易取得，臨床上護理人員對於新的儀器在應用上較不熟悉，故作者將相關文獻作一整理，希望能增加護理人員對心肺容積監視器的了解，以做為照護病人時體液補充及用藥的參考。本文主要介紹心肺容積監視器及其於敗血性休克病人的臨床應用，分兩部份介紹：一、心肺容積監視器簡介；二、心肺容積監視器於敗血性休克病人的臨床應用。心肺容積監視器簡介包括：原理、特殊設備、插管部位、液體溫度及注意事項。心肺容積監視器於敗血性休克病人的臨床應用包含：肺部參數、前負荷、心搏量變異率、心輸出量、後負荷、和心收縮力，並討論心肺容積監視器的優點、缺點及限制。

Septic shock is a common problem in the intensive care units. The Pulse-induced Contour Cardiac Output (PiCCO) has been available since the late 1990s. It was used to monitor hemodynamic changes in various types of patients, especially in septic shock patients. Due to the lack of Chinese version PiCCO related literature, the nurses are unfamiliar with the application of PiCCO. It is hoped that this article can serve as the reference to the health care providers when taking care of patients with PiCCO. The purpose of this article is to introduce PiCCO and to describe its clinical application in septic shock patients. The introductory section includes the mechanism, special equipments, catheter insertion sites, temperature of injectate, and precautions need to be taken. The clinical application of PiCCO in septic shock patients includes: pulmonary parameters, preload, stroke volume variation, cardiac output, afterload, and cardiac contractility. Finally, the advantages, disadvantages, and limitations of PiCCO were discussed.