早期有创脉搏指示连续心输出量监测对老年冠心病重症心力衰竭患者预后的影响

Assessment of PiCCO monitoring in elderly severe heart failure patients with CAD admitted to the CCU

目的观察早期有创脉搏指示连续心输出量(Pi CCO)监测对老年冠心病重症心力衰竭患者预后的影响。方法前瞻性选取2016年1月~2018年12月解放军总医院第二医学中心心脏监护室(CCU)住院治疗的老年冠心病重症心力衰竭患者45例,随机数表法分为Pi CCO监测(Pi CCO组)与常规监测(常规对照组),其中Pi CCO组25例,常规对照组20例;Pi CCO组年龄68~96岁,常规对照组年龄67~95岁;Pi CCO组测量包括心指数(CI)、全心舒张末期容积指数(GEDVI)、血管外肺水指数(EVLWI)、外周血管阻力指数(SVRI)、每搏量变异(SVV)等,两组患者均测量心脏超声左室射血分数(LVEF)、左室射血时间(LVET)、肺动脉压(PAP)等心功能指标、操作当日抽取静脉血,检测N末端脑钠肽前体(NT-proBNP)、心肌肌钙蛋白I/T(cTnI/T)、血肌酐(SCr)、血清白蛋白(Alb)。前瞻性随访观察患者心血管事件。结果两组间年龄、性别、LVEF、LVET、PAP、CVP、SCr、Alb,NT-proBNP、cTnI、cTnT等,差异均无统计学意义(P> 0.05)。两组老年冠心病重症心力衰竭患者30 d和随访1年复合终点事件(死亡、心肌梗死)的发生率差异无统计学意义(P> 0.05),Pi CCO组病死率呈降低趋势,差异无统计学意义(P> 0.05)。Kaplan-Meier生存分析显示,Pi CCO组累积心源性死亡低于常规对照组,差异有统计学意义(χ^2=5.47,P=0.019)。结论在老年重症心力衰竭患者中早期应用Pi CCO监测有降低心源性死亡、改善临床预后的趋势。

Objective To describe PiCCO parameters seen in elderly severe heart failure patients with CAD admitted to the Cardiac Care Unit(CCU)and secondly to investigate associations between hemodynamic measurements and survival data. Methods In this study 45 elderly heart failure patients with CAD admitted to a hospital CCU between January 2016 and December 2018 were prospectively investigated.The study sample was divided into two subgroups :patients monitored by PiCCO(n=25)and those monitored by central venous pressure(CVP)measurements(n =20),routine group.Cardiac index(CI),global end-diastolic volume index(GEDVI),extravascular lung water index(EVLWI),systemic vascular resistance index(SVRI),stroke volume variation(SVV)and mean arterial pressure(MAP)were messured using Piliip PiCCO2 performed by the same experienced doctor.All 45 patients were performed echocardiogram.LV ejection fraction(LVEF),LV ejection time(LVET)and pulmonary arterial pressure(PAP)were measured using transthoracic echocardiography with all measurements performed by the same experienced operator.Blood samples were drawn with standard precautions.Laboratory parameters were tested at the department of clinical chemistry.N-terminal Pro-brain nariuretic peptide(NTproBNP),cardic troponin I/T(cTnI/T),serum creatinine(SCr)and serum albumin(Alb)were tested. Results There were no significant differences in age,sex,LVEF,LVET,CVP,MAP,CVP,SCr,Alb,pro-BNP,cTnI,and cTnT(P > 0.05)between PiCCO monitor group and routine monitor group.There were no significant differences in cardiovascular events(death and myocardial infarction),of 30 days and 1 year,(85% vs 84%,P =0.735;44.0% vs 40.0%,P =0.787).Compared with routine monitor group,the cardiovascular death of 30 days and 1 year,at least as a tendency,were decreased in patients monitored by PiCCO(85% vs 88%,P=0.997;16.0% vs.35%,P =0.141).Furthermore,Kaplan-Meier analysis showed that the risk of cardiovascular death of 1 year were lower in Pi CCO group than that in the routine monitor group(log-rank test,P=0.019). Conclusion PiCCO monitor has a tendency to decrease the risk of cardiovascular death in elderly patiets with heart failure and CAD.