脉搏指示连续心排血量技术指导成人法洛四联症围术期治疗的随机对照研究  

A randomized control study on pulse indicator continuous cardiac output technique in the perioperative treatment of tetralogy of Fallot in adults

作　　者：张燕搏[1] 蒙延海[1] 杨克明[2] 黄海波[1] 常硕[1] 史晨[1] 张荣媛[1] 杨秋蓝[1] 刘子娜[1] 刘玲峰[1] 

机构地区：[1]国家心血管病中心中国医学科学院阜外医院外科ICU心血管疾病国家重点实验室,北京100037 [2]国家心血管病中心中国医学科学院阜外医院心外科心血管疾病国家重点实验室,北京100037

出　　处：《中华实用诊断与治疗杂志》2016年第5期455-457,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(81400305);北京市自然科学基金(7142137);中央级公益性科研院所基本科研业务费资助项目(2012F-14)

摘　　要：目的探讨脉搏指示连续心排血量(pulse indicator continuous cardiac output,PiCCO)技术在成人法洛四联症围术期治疗中的应用价值及意义。方法40例行手术治疗成人法洛四联症患者分为PiCCO组20例和对照组20例,PiCCO组根据放置PiCCO导管检测的相关数据进行血管活性药物及液体平衡管理,对照组根据常规检测数据对患者进行经验性处理,观察2组围术期指标、术后血管活性药物应用、液体负平衡及并发症发生情况,比较2组呼吸机时间、ICU时间和住院时间。结果 2组体外循环时间、主动脉阻断时间、胸腔置管引流时间、术后动脉血氧饱和度比较差异无统计学意义(P>0.05);PiCCO组呼吸机时间[(22.1±8.4)h]、ICU时间[(2.3±1.6)d]和住院时间[(6.8±2.6)d]明显低于对照组[(30.2±12.4)h、(3.2±2.3)d、(8.1±3.4)d](P<0.01);2组患者ICU期间血管活性药物应用情况比较差异无统计学意义(P>0.05);术后2组住院期间均无死亡,PiCCO组术后胸腔置管引流时间≥7d者2例、心律失常1例、因出血再次手术1例、切口愈合不良2例、二次入ICU0例,对照组分别为3例、3例、2例、1例、1例,2组比较差异无统计学意义(P>0.05)。结论应用PiCCO技术指导成人法洛四联症围术期治疗可促进患者早期恢复,安全、有效。Objective To explore the application and significance of pulse indicator continuous cardiac output （PiCCO） in perioperative treatment of tetralogy of Fallot in adults. Methods Forty adult patients scheduled for tetralogy of Fallot operation were randomly divided into PiCCO group and control group, with 20 patients in each group. According to the data of PiCCO detection, PiCCO group was treated with vasoactive drugs and liquid balance management, and control group was treated by routine monitoring data. The perioperative quotas, the application of vasoactive drugs, negative fluid balance and complications were observed, and ventilator time, ICU stay and hospitalization stay were compared between two groups. Results There were no significant differences in the cardiopulmonary bypass time, aortic clamping time, retaining tube in thorax for drainage time, and postoperative arterial oxygen saturation between two groups （P〉0.05）. The ventilator time （（22.1±8. 4） h）, ICU stay （（2. 3±1. 6） d） and hospitalization stay （（6. 8±2. 6） d） in PiCCO group were significantly shorter than those in control group （（30.2±12.4） h, （3.2 ±2.3） d, （8.1 ±3.4） d） （P〈0.01）. There was no significant difference in the drug dosage used in ICU between two groups （P〉0.05）. No hospitalization death occurred in either two groups. There were no significant differences in the incidences of postoperative chest tube drainage time ≥7 days, arrhythmia, reoperation due to bleeding, bad wound healing and re-entering into the ICU in PiCCO group （n=2, 1, 1, 2, 0） and control group （n=3, 3, 2, 1, 1） （P〉0. 05）. Conclusion PiCCO is safe and effective in the perioperative treatment of tetralogy of Fallot in adults and can promote the early recovery.

关 键 词：法洛四联症 脉搏指示连续心排血量 随机对照研究 

分 类 号：R654.2[医药卫生—外科学]