PiCCO在成人心脏术后容量管理的指导价值  

Guiding value of PiCCO in capacity management of adults undergoing the cardiac surgery

作　　者：程国栋[1] 李小芳[1] 朱春磊[1] 黄伟[1] CHENG Guodong;LI Xiaofang;ZHU Chunlei;HUANG Wei(Intensive Care Unit,Gaozhou People’s Hospital,Guangdong,Gaozhou 525200,China)

机构地区：[1]广东省高州市人民医院重症一区

出　　处：《中国医药科学》2019年第12期18-21,共4页China Medicine And Pharmacy

基　　金：广东省茂名市第一批(医疗卫生类)科技计划立项项目(2017037)

摘　　要：目的研究脉搏指示连续心排血量监测技术(PiCCO)在成人心脏术后容量管理的指导价值。方法选取2017年6月~2018年6月于我院心脏外科经体外循环行心脏外科手术的106例成人患者为研究对象,将其随机分为PiCCO指导容量管理组(A组,n=53)与经验治疗组(B组,n=53)。A组以PiCCO血流动力学指标:心输出量(CO)、心指数(CI)、胸腔内血管容量指数(ITBVI)、全心舒张末期容量指数(GEVDI)、血管外肺水指数(EVLWI)等指导容量管理;经验治疗组以心率、动脉血压、中心静脉压、尿量等指导容量管理。结果A组术后3d总液体出入量差值平均为(-591.9±135.8)mL/d,B组术后3d总液体出入量差值平均为(215.3±89.7)mL/d,差异有统计学意义(P<0.05);与B组比较,A组术后机械通气时间(30.4±9.6)h及ICU住院时间(4.6±1.8)d均短,心律失常发生率(5.7%)低,P<0.05;A组治疗3d后氧合指数(228.70±28.45)mmHg高于B组(186.94±35.17)mmHg,乳酸浓度(1.52±0.71)mmol/L、正性肌力药物评分(10.61±3.45)及BNP(127.46±36.89)pg/mL低于B组,P<0.05;但两组使用主动脉内球囊反搏(IABP)及持续性血液净化治疗(CRRT)例数及时间,治疗3d后的平均动脉压(MAP)及左室射血分数(LVEF),28d死亡率差异均无统计学意义(P>0.05)。结论PiCCO用于指导心脏术后危重患者进行精确的容量管理,可更有效改善心肺功能。Objective To study the guiding value of pulse indicating continuous cardiac output(PiCCO)in capacity management of adults undergoing the cardiac surgery. Methods 106 adult patients who under went cardiac surgery through extracorporeal circulation in department of cardiac surgery in our hospital from June 2017 to June 2018 were selected as research objects.They were randomly divided into the PiCCO guiding the capacity management group(A group,53 cases)and the experience treatment group(B group,53 cases).In A group,PiCCO hemodynamic indexes such as cardiac output(CO),cardiac index(CI),intrathoracic blood volume index (ITBVI),global end-diastolic volume index(GEDVI),and extravascular lung water index(EVLWI)were used to guide capacity management.In the experience treatment group,heart rate,arterial blood pressure,central venous pressure and urine volume were used to guide capacity management. Results The total fluid inflow and outflow in A group was(-591.9±135.8)mL/d on average and that in B group was(215.3±89.7)mL/d on average.There was statistical difference(P < 0.05).Compared with B group,postoperative mechanical ventilation time(30.4±9.6)h and ICU hospitalization time(4.6±1.8)d in A group were shorter and incidence of arrhythmia in A group was lower (5.7%),P < 0.05.After treatment for 3 days,the oxygenation index(228.70±28.45)mm Hg in A group was higher than that in B group(186.94±35.17) mm Hg while lactic acid concentration(1.52±0.71)mmol/L,positive inotropic drug score(10.61±3.45)and BNP(127.46±36.89)pg/mL were lower than those in group B,P < 0.05.However,there was no statistically significant difference in the number and time of patients treated with intra-aortic ballon pump (IABP)and continuous renal replacement therapy(CRRT),mean arterial pressure(MAP)and left ventricular ejection fraction(LVEF)after 3 days of treatment and 28-day mortality between the two groups(P > 0.05). Conclusion Application of PiCCO in guiding precise capacity management of critically ill patients undergoing the cardiac surger

关 键 词：PICCO 容量管理 心脏手术 血管容量 血管外肺水 

分 类 号：R541[医药卫生—心血管疾病]