PICCO检测在肺心病合并心源性休克中的应用价值分析  

The application of PICCO in the pulmonary heart disease complicated with cardiac shock

作　　者：董庆华[1] 汤展宏[1] 秦学斌[1] Dong Qinghua Tang Zhanhong Qin Xuebin(Second Department of Stomatology, the Affiliated Hospital of Guilin Medical College, Guilin,Guangxi 541001, China)

机构地区：[1]桂林医学院附属医院重症医学科二病区,广西桂林541001

出　　处：《重庆医学》2017年第23期3229-3230,3233,共3页Chongqing medicine

摘　　要：目的分析脉搏指示连续心输出量(PICCO)检测在慢性肺源性心脏病合并心源性休克中的应用价值。方法选择2014年1月至2015年3月该院收治的慢性肺源性心脏病合并心源性休克患者68例,分为研究组36例,对照组32例。两组均给予慢性肺源性心脏病合并心源性休克常规治疗,对照组同时行深静脉穿刺监测患者中心静脉压(CVP)变化。研究组在常规监测基础上行深静脉置管+股动脉置管+PICCO监测。观察两组治疗效果及研究组治疗期间PICCO指标变化。结果研究组患者应用血管活性药物时间、住院时间、机械通气时间均显著低于对照组,差异有统计学意义(P<0.05),两组病死率比较差异无统计学意义(P>0.05)。治疗后研究组患者心输出量(CI)显著升高,血管外肺水指数(EVLWI)和PVPI显著降低,组间差异有统计学意义(P<0.05),组间胸腔内血容量(ITBVI)比较差异无统计学意义(P>0.05)。研究组中存活组CI显著高于死亡组,EVLWI和PVPI显著低于死亡组(P<0.05),两组ITBVI比较差异无统计学意义(P>0.05)。结论 PICCO可以反映慢性肺源性心脏病合并心源性休克患者血流动力学情况,对于指导患者治疗和预后判断具有重要的临床价值。Objective To analyze the value of pulse sequential continuous cardiac output（PICCO） in chronic pulmonary heart disease with cardiogenic shock. Methods Sixty-eight patients with chronic pulmonary heart disease complicated with cardiogenic shock were randomly divided into study group（n= 36） and control group（n= 32）. Both groups were treated with conventional ther- apy,while the control group underwent deep venous puncture to monitor the central venous pressure （CVP） changes. The study group underwent deep venous catheterization＋ femoral artery catheterization monitoring ＋ PICCO monitoring. The therapeutic effect and the changes of PICCO index of the two groups were observed. Results The time of administration of vasoactive drugs, hospital stay and mechanical ventilation were significantly lower in the study group than in the control group （P〈0.05）. There was no significant difference in mortality rate between the two groups（P〈0.05）. After treatment,cardiac output quantity （CI） in study group increased significantly and extravascular lung water index EVLWI and PVPI decreased significantly, the difference between the two groups were statistical significance （P〈0.05）,ITBVI had no statistical significant difference betweent two groups（P〈0. 05）. CI in the survival group was significantly higher than the death group,PVPI and EVLWI were significantly lower than the death group （P〈0.05） ,and the two groups had no significant difference in ITBVI （P〈0.05）. Conclusion PICCO can reflect the hemodynamic status of patients with chronic pulmonary heart disease complicated With cardiac shock, and it has important clinical value for guiding the treatment and prognosis of patients.

关 键 词：肺心病 慢性病 休克 心原性 心排血量 预后 

分 类 号：R541.5[医药卫生—心血管疾病] R541.64[医药卫生—内科学]