脉搏轮廓持续心输出量监测在急性左心衰竭治疗中的指导价值

The Guiding Value of Monitoring With Pulse-induced Contour Cardiac Output in Treatment of Acute Left Heart Failure

目的:探讨脉搏轮廓持续心输出量(PICCO)在急性左心衰竭的血液净化(CBP)治疗中的目标导向性作用。方法:回顾性研究因急性左心衰竭出现呼吸衰竭需行机械通气的患者12例(联合组),在内科治疗基础上给予PiCCO监测下CBP治疗,比较治疗前后APACHEⅡ评分,容量指标(ITBVI、GEDVI、EVLWI)和心功能指数(CFI)。同时将该组患者和因相同疾病进行机械通气治疗的患者14例(常规组)进行比较,比较28d病死率、机械通气时间、住ICU时间,APACHEⅡ评分。结果:联合组在治疗后APACHEⅡ评分改善,ITBVI、GEDVI、EVLWI恢复正常,CFI改善;联合组病死率、机械通气时间、住ICU时间、APACHEⅡ评分均优于常规组。结论:CBP是治疗急性左心衰竭有效方法,而PiCCO为这种治疗提供了有效的指导。

Objective： To investigate the target directed effects of monitoring with pulse-induced contour cardiac output （ PiCCO） in treatment of acute left heart failure （ ALHF） by continuous blood purification （ CBP） . Methods： Twelve Cases （ combination group） with ALHF who developed respiratory failure requiring mechanical ventilation were retrospectively analyzed. On the basis of the medical treatment,patients were given CBP under the monitoring of PICCO. APACHE Ⅱ score, the capacity indicators （ ITBVI,GEDVI,EVLWI） and cardiac function index （ CFI） were compared before and after treatments. Meanwhile,28-day mortality rate,mechanical ventilation time,time of ICU stay and APACHEⅡ score were compared between patients of combination group and the other fourteen patients （ conventional group） with the same disease. Results： APACHE Ⅱ score was improved after treatments,ITBVI,GEDVI and EVLWI were returned to normal,and CFI was improved in combination group. The mortality rate,mechanical ventilation time,time of ICU stay and APACHE Ⅱ scores of combination group were superior to those of the conventional group. Conclusions： CBP is an effective means in treatment of ALHF,and PiCCO provides effective guidance for this treatment.