PiCCO指导左心功能低下冠状动脉旁路移植患者围术期治疗的研究

A randomized controlled study of PiCCO technology in guiding the perioperative treatment of patients undergoing coronary artery bypass grafting with preoperative left heart function hypofunction

目的探讨脉搏指示连续心排血量(PiCCO)技术在术前左心功能低下(LVEF<50%)的重症冠心病(CAHD)行冠状动脉旁路移植术(CABG)围术期治疗中的应用价值及指导意义。方法选择2017年1月~2018年12月于新疆心脑血管病医院在体外循环下行择期CABG治疗的CAHD患者80例,随机分为PiCCO组和对照组,每组各40例。PiCCO组根据置入PiCCO导管监测的相关数据进行容量管理及血管活性药物管理,对照组根据常规监测平均动脉压(MAP)及中心静脉压(CVP)对患者进行经验性处理。结果PiCCO组患者的机械通气时间、ICU时间及术后住院时间明显低于对照组,差异有统计学意义(分别为P=0.01、P=0.02、P=0.04)。PiCCO组在治疗6 h后GEDI、SVRI、CI及EVLWI均出现改善,组内比较有统计学意义(P均<0.05)。与治疗前相比,两组患者中脑钠肽水平治疗后24 h、72 h及出ICU时均明显降低,差异具有统计学意义(P<0.05)。PiCCO组患者在术后血管活性药物用量上明显低于对照组(分别P=0.01,P=0.04)。术后两组患者住院期间均无死亡,术后严重并发症发生率的差异均无统计学意义(P>0.05)。结论对于术前左心功能低下(LVEF<50%)的CAHD在CABG术后应用PiCCO技术监测血流动力学指标并指导治疗,可起到稳定循环,减轻肺水肿,提高组织灌注的作用,具有一定的安全性和有效性。

Objective To explore the application value and guiding significance of the pulse-indicating continuous cardiac output(PiCCO)technology in the perioperative treatment of severe coronary heart disease with preoperative left heart function(LVEF<50%)and coronary artery bypass grafting(CABG).Methods From January 2017 to December 2018,80 patients with CAHD who underwent elective CABG surgery under cardiopulmonary bypass were selected and randomly divided into PiCCO group and control group,with 40 cases in each group.The PiCCO group received volume management and vasoactive drug management based on the relevant data of PiCCO catheter monitoring,and the control group received empirical treatment based on routine monitoring of mean arterial pressure(MAP)and central venous pressure(CVP).Results The mechanical ventilation time,ICU time and postoperative hospitalization time of patients in the PiCCO group were significantly lower than those in the control group,and the differences were statistically significant(P=0.01,P=0.02,P=0.04,respectively).In the PiCCO group,GEDI,SVRI,CI and EVLWI all improved after 6 hours of treatment,and the comparison within the group was statistically significant(all P<0.05).Compared with before treatment,BNP levels in the two groups of patients were significantly reduced 24 h,72 h after treatment and when they were out of ICU,and the difference was statistically significant(P<0.05).The amount of vasoactive drugs in the PiCCO group was significantly lower than that in the control group(P=0.01,P=0.04,respectively).There was no death during the hospitalization of the two groups of patients after the operation,and there was no significant difference in the incidence of serious postoperative complications(P>0.05).Conclusion For severe coronary heart disease with low left ventricular function(LVEF<50%)before operation,PiCCO technology is used to monitor hemodynamic indicators and guide treatment after CABG,which can stabilize circulation,reduce pulmonary edema,and improve tissue perfusion with certain degree of safety and effectiveness.