脉搏指示连续心排血量监测在冠状动脉旁路移植术后低心排血量患者中的应用  

Pulse Indicated Continuous Cardiac Output for Low Cardiac Output Patients after Coronary Artery Bypass Grafting

作　　者：李菲[1] 贾明[1] 董平[1] 侯晓彤[1] 

机构地区：[1]首都医科大学附属北京安贞医院心脏外科危重症中心,北京100029

出　　处：《中国胸心血管外科临床杂志》2016年第3期239-243,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的 分析脉搏指示连续心排血量监测（PICCO）应用于冠状动脉旁路移植（CABG）术后低心排血量（LCOS）患者进行血流动力学监测对治疗的指导意义。方法 回顾性分析2013年6月至2014年10月期间首都医科大学附属北京安贞医院非体外循环CABG术后发生LCOS110例患者的临床资料,根据术后是否应用PICCO进行血流动力学监测将患者分为两组：PICCO组（n=49）,男29例、女20例,年龄（60.80±9.34）岁;非PICCO组（n=61）,男37例、女24例,年龄（62.22±10.41）岁。比较两组患者的治疗效果。结果 PICCO组与非PICCO组比较,术后应用IABP时间短（t=2.155,P=0.039）、术后二次气管插管率低（χ~2=5.098,P=0.039）、术后机械通气平均时间短（t=2.087,P=0.044）、术后心律失常发生率低（χ~2=4.011,P=0.045）、术后多器官功能障碍综合征（MODS）发生率低（χ~2=5.075,P=0.035）、住ICU时间短（t=2.141,P=0.040）及住院时间短（t=2.061,P=0.048）;监测期间,PICCO组与非PICCO组比较,平均心律慢、平均动脉压高、血乳酸值低、氧合指数高、左心室射血分数高。结论 在PICCO监测下指导治疗,能降低CABG术后LCOS并发症的发生率,提高疗效。Objective To analyze the significance of application of pulse indicated continuous cardiac output （PICCO） as hemodynamic monitoring for low cardiac output patients after coronary artery bypass grafting （CABG） operation. Method We retrospectively analyzed the clinical data of 110 patients conducted non-extracorporeal circulation CABG operation in Beijing Anzhen Hospital between June 2013 and October 2014. The patient were divided into two groups including a PICCO applied group and a non-PICCO applied group. There were 49 patients including 29 males and 20 females at average age of 60.80＋9.34 years in the PICCO group. There were 61 patients with 37 males and 24 females at age of 62.22±10.41 years in the non-PICCO group. We compared the treatment effects between the two groups. Result Comparing to the non-PICCO group, the PICCO group had shorter average days of postoperative intra-aortic balloon pump （IABP） usage （t=2.155, P=0.039）, less usage rate of endotracheal reintubation （X2=5.098, P=0.039）, shorter average posto- perative mechanical ventilation time （t=2.087, P=0.044）, less occurrence rate of cardiac arrhythmia （X2=4.011, P=0.045）, less occurrence rate of multiple organ dysfunction syndrome （MODS） （X2=5.075, P=0.035）, shorter days in ICU （t=2.141, P=0.040） and in-hospital time （t=2.061 P=0.048）. During monitoring, the PICCO group had slower average heart rate, higher average arterial pressure, lower blood lactate, greater oxygenation and greater left ventricular ejection fraction （LVEF） than those in the non-PICCO group. Conclusion The application of PICCO reduces occurrence of postoperative complications for low cardiac output patients with post coronary artery bypass grafting operation, increases cure rate.

关 键 词：冠状动脉旁路移植术 脉搏指示连续心排血量监测 低心排血量综合征 

分 类 号：R654.2[医药卫生—外科学]