应用PICCO监测指标指导严重心力衰竭患者容量管理的效果

Fliud management by PICCO in patients with severe heart failure

目的应用脉搏指数连续心输出量监测（PICCO）监测指标指导严重心力衰竭患者的容量管理，以指导临床液体治疗及护理。方法选择收住ICU的APACHE11评分≥16分心力衰竭患者，所有纳入患者均行PICCO监测，采用随机数字表法随机分为常规组与限制组，每组各12例。常规组：根据PICCO监测数据给予开放性液体管理；限制组：在上述临床监测基础上实施限制性液体管理。比较两组患者7d累积液体输注量、7d累积液体净平衡量、ICU住院时间、达到液体负平衡时间和并发症的发生率。结果限制组与常规组7d累积液体输注量[（28308．4±5583．0）ml比（36650．3±6099．8）m1]、7d累积液体净平衡量[（5865．1±2182．1）ml比（9282．0±2578．3）m1]、达到液体负平衡时间[（4．86±1．77）d比（7．43±1．27）d]、ICU住院时间[（8．14±1．86）d比（10．29±1．50）d]，差异均有统计学意义（t值分别为一2．714，一2．676，一3．118，一2．372；P均〈0．05）。限制组2例、常规组6例患者出现并发症，经Fisher’s检验，差异无统计学意义（P〉0．05）。结论通过PICCO监测指标指导心力衰竭患者液体管理及护理，及时调整输液治疗与护理方案，能大大提高治疗效果，促进患者康复。

Objective Applying PICCO in the volume administration for heart failure patients in order to guide the clinical liquid treatment and nursing. Methods Heart failure patients whose score of APACHE II more than 16 were admitted in ICU and randomly divided into conventional group（ rt = 12） and limited group （n =12 ）. The conventional group received the traditional liberty fliud management according to the hemodynamic data monitored by PICCO. On the basis of those clinic monitoring, the limited group received restrictive fliud management. Then, the data of mean cumulative fluid input and net balance quantity of liquid from lth day to 7th day, stay time in ICU,needing time of nagative fliuld balance, ICU length of stay and the incidence of complications were collected. Results Compared the limited group to conventional group, the data of mean cumulative fuid input from lth day to7th day, [ （28308.4 ±5 583.0）ml vs （36650.3 ±6099.8）ml], the net balance of liquid [ （5 865.1 ± 2 182.1 ） ml vs （9 282.0 ±2 578.3 ） ml ] from I th day to 7th day, needing time of nagative fliuld balance [ （4.86±1.77 ） d vs （7.43 ± 1.27 ） d ], and ICU length of stay [ （ 8.14 ＋ 1.86 ） d vs （10.29± 1.50 ）d] were significant different （P 〈 0.05 ）. There were 2 cases had complications in limited group, and that of conventional group were 6 cases, and the difference was not significant （ P 〉 0.05 ）. Conclusions The clinical liquid treatment and nursing for patients with heart failure according to the PICCO system monitoring, which can improve the effect of outcome and promote their rehabilitation.