脉搏指示连续心排血量监测技术在重度心力衰竭治疗中的应用研究

Study of pulse-indicated continuous cardiac output technique applied to treatment of Advanced Heart Failure

目的探讨脉搏指示连续心排血量监测(Pi CCO)技术在重度心力衰竭患者治疗中的应用效果。方法将60例重度心力衰竭患者按随机数字法分为治疗组与对照组,各30例。治疗组采用Pi CCO技术监测血流动力学指标:心脏指数(CI)、胸腔内血容积指数(ITBVI)、血管外肺水指数(EVLWI)、系统血管阻力指数(SVRI)等指导液体管理及血管活性药物应用;对照组根据中心静脉压(CVP)变化指导治疗。比较两组患者机械通气时间、ICU住院时间、治疗后28 d病死率的不同;观察治疗组治疗前后CI、ITBVI、EVLWI、SVRI的变化;观察治疗组死亡与存活患者治疗前及治疗3 d后EVLWI的变化。结果治疗组机械通气时间、ICU住院时间、治疗后28 d病死率均低于对照组(P<0.05);治疗组治疗后ITBVI、EVLWI、SVRI恢复正常,与治疗前比较差异有统计学意义(P<0.05),CI改善与治疗前比较,差异有统计学意义(P<0.05);治疗组患者死亡7例,存活23例;治疗组存活与死亡患者治疗前EVLWI水平比较,差异无统计学意义(P>0.05);存活患者治疗3天后EVLWI水平明显低于治疗前,且明显低于死亡患者(P<0.05)。结论利用Pi CCO监测指标指导重度心力衰竭治疗,可改善患者心功能,减少机械通气时间及ICU住院时间,降低病死率;动态观察EVLWI可评估患者预后。

Objective To explore the clinical effect of pulse-indicated continuous cardiac output（PiCCO） technique on the treatment of patients with advanced heart failure .Methods Sixty cases of advanced heart failure were randomly divided into treatment group and control group,with 30 cases in each group .PiCCO technique was adopted to monitor the hemodynamic parameters for the guidance of fluid therapy and vasoactive agents usage in the treatment group .The hemodynamic parameters included cardiac index （CI）,intrathoracic blood volume index（ITBVI）,extravascular lung water index （EVLWI） and systemic vascular resistance index （SVRI）.However,the treatment was performed according to the changes in central venous pressure （ CVP ） in the control group .The mechanical ventilation duration , intensive care unit（ICU） stay,and 28-day mortality after treatment were compared between two groups .The changes in CI,ITBVI,EVLWI and SVRI were observed in the treatment group before and after treatment .The changes in EVLWI of deaths and survivors were observed in the treatment group before and 3 days after treatment .Results The mechanical ventilation duration ,ICU stay,and 28-day mortality after treatment in the treatment group were significantly lower than those in the control group （P＆lt;0.05）.After treatment,ITBVI,EVLWI,SVRI in the treatment group became normal while CI improved , which showed a significant difference in contrast with those before treatment （P＆lt;0.05）.There were 7 cases died and 23 cases survived in the treatment group .No significant differences were found in the level of EVLWI between survivors and deaths in the treatment group before treatment （P＆lt;0.05）,and the level of EVLWI of survivors in 3-day treatment was significantly lower than that before treatment and of deaths （P＆lt;0.05）.Conclusion The treatment of advance heart failure guided by PiCCO monitoring can improve the patients′heart function,reduce mechanical ventilation duration and ICU stay ,and decrease fatality rate.Dynamic observation on EVLWI can be used to assess the prognosis of these patients .