PICCO监测技术在重症心脏病术后的临床应用
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摘要
目的:探讨脉搏指数连续心输出量监测(Pi CCO)在重症心脏术后患者血流动力学动态变化中的应用价值。方法:对我重症病房的心脏术后患者30例行Pi CCO监测,记录患者术后4 h、12 h、24 h和48 h患者血流动力学指标的动态变化,包括心功能指数(CFI)、血管外肺水肿指数(EVLWI)、外周血管阻力指数(SVRI)及CVP,检测患者血脑钠肽(BNP)水平,分析血流动力学指标与BNP的相关性,评估Pi CCO监测下的临床治疗效果。结果:在Pi CCO监测下,患者使用血管活性药物的最短时间为7天,平均(8.76±1.02)天,入住ICU和机械通气时间分别为(9.66±1.25)和(7.95±1.36)天,随着术后时间延长,CFI增加,EVLWI降低,SVRI术后4 h和12 h降低,24 h后逐渐升高恢复平稳,上述指标不同时间点比较差异具有统计学意义(P<0.05)。Spearman相关分析显示EVLWI与BNP呈正相关(r=0.88,P<0.05),而CFI与BNP呈负相关(r=-0.47,P<0.05),而SVRI和CVP均与BNP无显著相关性(P>0.05)。结论:PICCO监测技术可反映心脏术后患者血流动力学指标的动态变化情况,降低术后风险性,提高临床治疗效果。
Objective:To study the value of Pi CCO in patients with severe postoperative cardiac about the change of hemodynamic dynamic Methods:30 cases of patients were monitored with Pi CCO after postoperative at 4 h,12 h,24 h and 48 h. The hemodynamic parameters including CFI,EVLWI,SVRI and CVP were observed. BNP levels were detected and the correlation between parameters and BNP were analyzed. Results:Under the Pi CCO,the time with vascular active drugs,mechanical ventilation time and ICU time were(8.76 ± 1.02)days,(9.66 ±1.25)and(7.95 ±1.36)respectively. With postoperative time prolonged,the CFI increased and EVLWI reduced,SVRI reduced postoperative 4h and 12 h too,and significant gradually rising after 24h(P<0.05). Spearman correlation analysis showed the BNP and EVLWI had positive correlation,while the BNP and CFI had negatively correlated,and SVRI and CVP were no significant correlation with BNP(P>0.05). Conclusion:PICCO technology can reflect the dynamic change of hemodynamic parameters in patients with cardiac surgery and reduce postoperative risk. It can improve the effect of clinical treatment.
Objective:To study the value of Pi CCO in patients with severe postoperative cardiac about the change of hemodynamic dynamic Methods:30 cases of patients were monitored with Pi CCO after postoperative at 4 h,12 h,24 h and 48 h. The hemodynamic parameters including CFI,EVLWI,SVRI and CVP were observed. BNP levels were detected and the correlation between parameters and BNP were analyzed. Results:Under the Pi CCO,the time with vascular active drugs,mechanical ventilation time and ICU time were(8.76 ± 1.02)days,(9.66 ±1.25)and(7.95 ±1.36)respectively. With postoperative time prolonged,the CFI increased and EVLWI reduced,SVRI reduced postoperative 4h and 12 h too,and significant gradually rising after 24h(P<0.05). Spearman correlation analysis showed the BNP and EVLWI had positive correlation,while the BNP and CFI had negatively correlated,and SVRI and CVP were no significant correlation with BNP(P>0.05). Conclusion:PICCO technology can reflect the dynamic change of hemodynamic parameters in patients with cardiac surgery and reduce postoperative risk. It can improve the effect of clinical treatment.
引文
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[9]王绍林,张进.Pi CCO血流动力学监测在心脏手术麻醉诱导期应用评价[J].河北联合大学学报(医学版),2013,15(2):153.
[10]Rhodes A,Cusack RJ,Newman PJ,et al.A randomized,controlled trial of the pulmonary artery catheter in critically ill patients[J].Intensive Care Med,2002,28(3):256.
[2]OConnor CM,Rogers JG.Evidence for overturning the guidelines in cardiogenic shock[J].N Engl J Med,2012,367(10):1349.
[3]吴宪宏,卿恩明.PICCO监测指导非体外循环下冠状动脉旁路移植术患者围术期容量治疗的效果[J].中华麻醉学杂志,2008,28(9):840
[4]黄馨,李映梅,杨顺银,等.PICCO在重症急性胰腺炎早期液体复苏中的应用[J].海南医学院学报,2014,20(9):1208.
[5]夏柄杰,施善阳.PICCO监测对SAP合并ARDS患者心功能心脏前后负荷及血管外肺水的观察作用[J].河北医学,2016,22(5):766.
[6]Sakka SG,Ruhl CC,Pleilfer UJ,et al.Assessment of cadiac preload and extravascular lung water by single transpulmonary thermodilution[J].Intensive Care Med,2002,26(2):180.
[7]Belda FJ,Aguilar G,Teboul JL,et al.Complications related to less-invasive haemodynamic monitoring[J].Br J Anaesth,2011,106(4):482.
[8]郭晓纲,王继宏.Pi CCO技术在心脏瓣膜置换术中血流动力学监测的应用[J].热带医学杂志,2013,13(3):316
[9]王绍林,张进.Pi CCO血流动力学监测在心脏手术麻醉诱导期应用评价[J].河北联合大学学报(医学版),2013,15(2):153.
[10]Rhodes A,Cusack RJ,Newman PJ,et al.A randomized,controlled trial of the pulmonary artery catheter in critically ill patients[J].Intensive Care Med,2002,28(3):256.