PiCCO在合并有基础心脏病的脓毒症患者血流动力学应用中的临床意义

The Clinical Significance of Hemodynamic Monitoring with PiCCO Technique in Septic Patients with Cardiac Disease

目的:探讨使用脉搏波波指示连续心排血量(Pi CCO)监测仪监测合并有基础心脏病的脓毒症患者血流动力学的变化特点及临床意义。方法:将2016年2月-2017年2月收治的52例脓毒症患者依据病史及入住ICU时心脏彩色多普勒超声,根据射血分数分为A1组(有心脏基础病、EF<55%,20例)、A2组(有心脏基础病、EF≥55%,16例)、A3组(无心脏基础病、EF≥55%,16例),分别于诊断开始0、12、24、36、48、72小时利用PiCCO监测仪对胸腔内血管容量(ITBV)、血管外肺水指数(EVLW)、CI(心指数)及外周循环阻力(SVRI)进行监测,并比较三组患者治疗28天的死亡率,并将结果进行统计学分析。结果:于24小时之内A1组CI、SVRI明显低于A2、A3组,而EVLWI、ITBV明显升高(P<0.05);A2组与A3组比较,于24小时之后CI、SVRI低,EVLWI、ITBV高,差异有统计学意义(P<0.05)。A1、A2组的APACHEⅡ评分、机械通气时间与28天死亡率明显高于A3组(P<0.05)。结论:Pi CCO监测能够及时地、有效地发现合并有基础心脏病脓毒症患者休克时心功能变异及低循环动力学阶段的出现,能更好地指导合并有基础心脏病脓毒症患者液体复苏及强心药、血管活性药物等使用的时机。

Objective:To investigate the characteristics of hemodynamic and clinical value in septic patients with cardiac disease monitored by pulse indicator continuous cardiac output(PiCCO). Methods:The data of 52 patients with sepsis admitted to the department of critical care medicine of the nanshan hospital of shenzhen university from February 2016 to February 2017 were enrolled. According to history and the examination of doppler echocardiography which mainly marked by left ventricular ejection fraction(LVEF),all patients were divided into three groups:A1 group(with cardiac disease,LVEF≤55%,20 cases);A2 group(with cardiac disease,LVEF>55%,16 cases),A3 group(without cardiac disease,LVEF≥55%,16 cases). The hemodynamic parameters were monitored by Pi CCO and recorded after diagnose 0 hours,12 hours,24 hours,36 hours,48 hours and 72 hours,including intra-thoracic blood volume index(ITBVI),extra-vascular lung water index(EVLWI),cardiac index(CI),and systemic vascular resistance index( SVRI). 28-day mortality rates of three groups were compared also. Results:Compared with A2 and A3 group,CI and SVRI were significantly decreased,EVLWI and ITBVI were significantly increased before 24 hours in A1 group(P<0.05). Compared with A3 group,CI and SVRI were significantly decreased,EVLWI and ITBVI were significantly increased after 24 hours in A2 group(P<0.05). Compared with A3 group,APACHEⅡscoring,mechanical ventilation time and 28-day mortality rates were significantly increased in A1 group and A2 group(P<0.05).Conclusion:Pi CCO monitoring technology can find variation of heart function and hemodynamic timely and effectively during shock period for septic patients with cardiac disease. And also have certain value for the patients in guiding fluid resuscitation and employing of cardio-tonic drugs and vasoactive drugs.