重症超声与PiCCO监测指导急性心力衰竭容量管理的临床研究  

Clinical study of critical ultrasound and pulse-indicated continuous cardiac output monitoring to guide capaciyu management of acute heart failure

作　　者：黄彪 陈勇 胡大碧 左丹 王友华 张苜[2] 余应喜[2] Huang Biao;Chen Yong;Hu Dabi;Zuo Dan;Wang Youhua;Zhang Mu;Yu Yingxi(Department of Critical Care Medicine,The Dazu District People’s Hospital;Department of Critical Care Medicine,First Affiliated Hospital of Chongqing Medical University)

机构地区：[1]重庆市大足区人民医院重症医学科,重庆402360 [2]重庆医科大学附属第一医院重症医学科,重庆400016

出　　处：《重庆医科大学学报》2020年第10期1431-1437,共7页Journal of Chongqing Medical University

基　　金：重庆市卫计委医学科研资助项目(编号:2017MSXM184);重庆市科委资助项目(编号:cstc2019jscx-msxm0426)。

摘　　要：目的:探讨重症超声与脉搏指示持续心排血量(pulse-indicated continuous cardiac output,PiCCO)对急性心力衰竭(acute heart failure,AHF)患者的容量管理,对比2种方式早期治疗效果,在治疗及时性方面为患者提供一定的科学依据。方法:选择2017年1月至2018年9月重庆市大足区人民医院重症监护室(intensive care unit,ICU)收治的符合入选标准的AHF患者,随机分为试验组(n=30)和对照组(n=28)。试验组采用重症超声监测指导,对照组采用PiCCO监测指导,对比2组患者72 h内的N末端B型利钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、中心静脉压(central venous pressure,CVP)、平均动脉压(mean arterial pressure,MAP)、乳酸清除率、中心静脉血氧饱和度(central venous oxygen saturation,ScvO2)的情况;统计肺部感染发生率、机械通气时间、ICU入住时间、28 d死亡率、生存曲线、6 h复苏达标情况及3 h内能进行容量监测的例数;2种监测方法在治疗前后的心功能,血容量指标比较情况。结果:72 h 2组NT-proBNP、CVP、MAP、乳酸清除率、ScvO2差异均无统计学意义(P>0.025)。2组患者肺部感染发生率对照组大于试验组,差异有统计学意义(P<0.025)。3 h内能进行容量监测的例数,试验组明显多于对照组,差异有统计学意义(P<0.05)。2组6 h容量达标人数差异无统计学意义(P>0.05)。2组患者在机械通气时间、ICU入住时间、28 d死亡率、生存时间方面差异均无统计学意义(P>0.05)。治疗前后心功能指标对比:试验组治疗前心输出量(cardiac output,CO)、左心射血分数(left ventricular ejection fraction,LVEF)指标小于治疗后,差异均有统计学意义(P<0.05);对照组治疗前心脏指数(cardiac index,CI)、全心射血分数(global ejection fraction,GEF)指标小于治疗后,差异有统计学意义(P<0.05)。治疗前后血容量指标对比:试验组治疗后下腔静脉呼吸异变率、左心室舒张末期容积(left ventricular end diastObjective:To explore the capacity management of critical ultrasound and pulse-indicated continuous cardiac output(PiCCO)in patients with acute heart failure(AHF)and to compare the early therapeutic effect of those two methods,so as to provide a scientific basis for timely treating patients. Methods :AHF patients who met the admission criteria were selected from January2017 to September 2018 in the intensive care unit(ICU)of Dazu District People’s Hospital and were randomly divided into the experimental group(n=30) and the control group(n =28). The experimental group was guided by critical ultrasound monitoring,while the control group was guided by PiCCO monitoring.The N-terminal pro-brain natriuretic peptide(NT-proBNP),central venous pressure(CVP),mean arterial pressure(MAP),lactate clearance rate and central venous oxygen saturation(ScvO2)within 72 hours were compared among patients in two groups. The incidence of pulmonary infection,mechanical ventilation time,ICU occupancy time,28-day mortality rate,survival curve,6-hour recovery and the number of cases that can be monitored within 3 hours were statistically recorded. Pre-and-post-treatment cardiac function and blood volume indexes of the two monitoring methods were compared. Results:NT-proBNP,CVP,MAP,lactate clearance and ScvO2 at the 72 nd hour in two groups had no statistically significant difference(P>0.025). The incidence of pulmonary infection in the experimental group was higher than that in the control group,with statistically significant difference(P<0.025). The number of cases of capacity management that could be monitored within 3 hours in the experimental group was significantly higher than that in the control group,with statistically significant difference(P<0.05). The number of cases of capacity management that could be monitored within 6 hours in two groups had no statistically significant difference(P>0.05). Mechanical ventilation time,ICU stay time,28-day mortality and survival time in two groups had no statistically significant difference(P

关 键 词：急性心力衰竭 重症超声 脉搏指示持续心排血量 容量管理 

分 类 号：R459.7[医药卫生—急诊医学]