目的:探讨脉搏轮廓心输出量(PiCCO)监测技术在严重烧伤患者休克期液体复苏中的应用。方法:2015年1月—2019年12月，广州市红十字会医院烧伤整形科收治的33例特重度烧伤患者符合入选标准，采用回顾性队列研究分析其临床资料。根据采用的监测方法，将患者分为PiCCO监测组15例[男13例、女2例，年龄（43±13）岁]与常规监测组18例[男14例、女4例，年龄（39±9）岁]。患者入院后均按照第三军医大学休克期补液公式进行补液，常规监测组通过监测患者尿量、血压等指标进行液体复苏；PiCCO监测组患者行PiCCO监测，在常规监测组监测指标的基础上，综合患者情况及PiCCO监测的血流动力学参数（不追求参数达到正常水平）指导液体复苏。统计2组患者伤后第1、2个24 h的胶体系数与电解质系数（同时将伤后第1个24 h胶体系数、电解质系数与第三军医大学休克期补液公式值0.75 mL·kgn -1 ·%TBSAn -1比较）、总补液系数、尿量，入院时及入院后24、48 h乳酸、碱剩余水平及氧合指数，机械通气时间、创面愈合时间、病死比例；统计PiCCO监测组患者伤后24、48、72 h心脏指数、全心舒张末期容积指数（GEDVI）、胸腔内血容量指数（ITBVI）、血管外肺水指数（EVLWI）、外周血管阻力指数（SVRI）水平及这些指标异常的例数。对数据行Fisher确切概率法检验、独立样本或单样本n t检验、重复测量方差分析、Bonferroni校正。n 结果:PiCCO监测组患者伤后第1个24 h的胶体系数为（0.69±0.15）mL·kgn -1·%TBSAn -1，明显少于常规监测组的（0.85±0.16）mL·kgn -1·%TBSAn -1（n t=-2.612，n P0.05）。PiCCO监测组患者入院后24 h乳酸及碱剩余水平分别为（4.8±1.4）、（1.2±5.5）mmol/L，明显优于常规监测组的（7.0±1.5）、（-2.8±3.0）mmol/L（n t=-3.904、2.562，n P0.05）。PiCCO监测组患者GEDVI和ITBVI在伤后24、48 h低于正常值低值，在伤后72 h处于正常值范围;心脏指数逐渐升高，于伤后48 h恢复正常；SVRI在伤后24 h显著升高后逐渐下降至正常，EVLWI在伤后各时间点均小于10 mL/kg。伤后24 h，PiCCO监测组8/15的患者大部分血流动力学参数异常，之后异常比例有所下降。n 结论:在常规监测指标的基础上，采用PiCCO监测技术结合患者综合情况，不以血流动力学参数正常为目标指导严重烧伤患者液体复苏，可减少胶体的使用量，更好地改善组织灌注，复苏效果优于常规监测。“,”Objective:To investigate the application of pulse contour cardiac output (PiCCO) monitoring technology in fluid resuscitation of severe burn patients during shock stage.Methods:From January 2015 to December 2019, 33 patients with extremely severe burn hospitalized in Guangzhou Red Cross Hospital, meeting the inclusion criteria, were recruited to conduct a retrospective cohort study with their clinical material. The patients were divided into PiCCO monitoring group with 15 cases (13 males and 2 females, aged (43±13) years) and routine monitoring group with 18 cases (14 males and 4 females, aged (39±9) years) according to the monitoring method. After admission, all the patients were rehydrated according to the rehydration formula of the Third Military Medical University during shock stage. In routine monitoring group, the fluid resuscitation of patients was performed by monitoring indicators such as urine volume and blood pressure, while PiCCO monitoring was performed among patients in PiCCO monitoring group, and their fluid resuscitation was guided by the patient's condition and the hemodynamic parameters (without pursuing normal levels of the parameters) of PiCCO monitoring on the basis of normal monitoring indicators in routine monitoring group. The colloids coefficients, the electrolyte coefficients (compared with the corresponding rehydration formula value of 0.75 mL·kgn -1 ·%TBSAn -1 of the Third Military Medical University during shock stage at the same time), the rehydration coefficients, and the urine volumes during the first and second 24 h post injury, the lactic acid level, the base excess level, and the oxygenation index at admission and 24, 48 h after admission, and the mechanical ventilation time, the wound healing time, and the mortality of patients in the two groups were recorded. The cardiac index, the global end-diastolic volume?index (GEDVI), the intrathoracic blood volume?index (ITBVI), the extravascular lung water index (EVLWI), and the systemic vascular resistance?index (SVRI) of patients in PiCCO monitoring group at post injury hour (PIH) 24, 48, and 72 and the abnormal cases were recorded. Data were statistically analyzed with Fisher’s exact probability test, independent-sample or one-sample n t test, analysis of variance for repeated measurement, and Bonferroni correction.n Results:During the first 24 h post injury, the colloids coefficients in PiCCO monitoring group (0.69±0.15 mL·kgn -1·%TBSAn -1) was significantly less than 0.85±0.16 mL·kgn -1·%TBSAn -1 of routine monitoring group (n t=-2.612, n P0.05). The levels of lactic acid and base excess of patients in PiCCO monitoring group were (4.8±1.4) and (1.2±5.5) mmol/L, respectively, which were significantly better than (7.0±1.5) and (-2.8±3.0) mmol/L in routine monitoring group at 24 h after admission (n t=-3.904, 2.562, n P0.05). In PiCCO monitoring group, the GEDVI, and the ITBVI of patients were lower than the normal low values at PIH 24 and 48, which were in the normal range at PIH 72; the cardiac index of patients increased gradually and recovered to normal at PIH 48; the SVRI of patients increased significantly at PIH 24 and then gradually decreased to normal; the EVLWI of patients at all time points post injury were less than 10 ml/kg. At PIH 24, most of the hemodynamic parameters of 8/15 patients in PiCCO monitoring group were abnormal, and then the abnormal proportion decreased.n Conclusions:On the basis of traditional monitoring indicators, the use of PiCCO monitoring technology combined with the patient's condition (without pursuing normal levels of the parameters) in guiding the fluid resuscitation in severe burn patients can reduce the usage of colloid and better improve tissue perfusion, with better resuscitation effect than conventional monitoring.