PICCO在机械通气患者撤机中的应用

Clinical value of PICCO in weaning of mechanical ventilation patients

目的探讨脉搏指示连续心排量监测（PICCO）在机械通气患者撤机中的应用价值。方法前瞻性收集我院2013-01-2013-1058例机械通气患者的资料，根据撤机是否成功分为撤机成功组38例和撤机失败组20例，PICCO监测撤机前15min及撤机后15min、30min、48h或再插管时的血流动力学参数：血管外肺水指数（EVLWI）、全心舒张末期容积（GEDVI）、胸腔内血容积指数（ITBVI）和肺血管通透性指数（PVPI）。结果撤机失败组患者的APACHEⅡ评分、机械通气时间、血肌酐（Cr）显著高于撤机成功组（P＜0．05），血白蛋白水平低于后者（P＜0．05）。撤机前15min、撤机后15min两组血流动力学参数比较均差异无统计学意义（P＞0．05），撤机后30min撤机失败组的GEDVI和ITBVI均比撤机成功组升高（t值分别：-3．261、-3．828，均P＜0．01）；撤机后48h或再插管时撤机失败组的EVLWI、GEDVI、ITBVI、PVPI均比撤机成功组升高，（t值分别：-8．788、-4．668、-4．270、-6．884，均P＜0．01）。结论PICCO监测的血流动力学指标有利于早期发现撤机失败导致的肺水肿，对临床有一定的指导价值。

Objective To explore the clinical value of pulse index continuous cardiac output （ PICCO） in weaning of mechanical ventilation patients.Methods We prospectively analyzed the data of 58 cases from Jan, 2013 to Jun, 2013 in our hospital, which were divided into two groups including weaning successful group （n=38） and weaning failure group （n=20）.Extravascular lung water index （ EVLWI） , global end diastolic volume index （ GEDVI） , intra-thoracic blood volume index （ ITBVI） , pulmonary vascular permeability index （ PVPI） were monitored by PICCO at the time points including 15 min before weaning, 15 min after weaning, 30 min after weaning, and 48 hours after weaning or reintubation.Results The APACHEⅡscore, the duration of ventilator and Cr value of weaning failure group were higher than weaning successful group （P 〈0.05）, and the ALB value was lower than weaning successful group （P〈0.05）.There were no statistic differences between the two groups when before and after weaning 15 min （P〉0.05）.After weaning 30 min the GEDVI and ITBVI of weaning failure group were higher than which of weaning successful group （ t values were -3.261, -3.828, P〈0.01）.Also after weaning 48 hours or reintubation the EVLWI, GEDVI, ITBVI and PVPI of weaning failure group were higher than which weaning successful group （ t values were -8.788,-4.668, -4.270, -6.884, P〈0.01）.Conclusion The PICCO monitoring benefits early diagnosis of pulmonary edema induced by weaning, which provides reliable instructions for clinical use.