摘要目的 探讨脉搏指示连续心排血量监测(PiCCO)在重症心力衰竭(心衰)患者治疗管理中的应用价值.方法 选择福建省立医院重症医学科(ICU)2017年8月至2019年2月因重症心衰入院的60例患者,按照随机数字表法将患者分为对照组和治疗组,每组30例.治疗组运用床边PiCCO进行微创血流动力学监测,根据监测数据目标导向进行血管活性药物及液体管理;对照组根据传统心电监测、肺部啰音、尿量进行血管活性药物及液体管理.观察治疗组治疗前及治疗72 h心排血指数(CI)、全心舒张期末容积指数(GEDVI)、血管外肺水指数(EVLWI)、外周血管阻力指数(SVRI)、有创平均动脉压(MAP)、中心静脉压(CVP)的变化;比较两组治疗7 d总有效率、ICU住院时间和28 d病死率.结果 治疗组治疗后CI、MAP较治疗前明显升高〔CI(mL·s-1·m-2):53.34±16.67比35.01±13.34,MAP(mmHg,1 mmHg=0.133 kPa):72.6±10.6比62.5±10.3,均P<0.05〕,GEDVI、EVLWI、SVRI、CVP较治疗前明显下降〔GEDVI(mL/m2):760.3±90.2比960.2±110.3,EVLWI(mL/kg):6.5±1.3比12.5±6.2,SVRI(kPa·s·L-1·m-2):297.3±35.1比434.1±58.8,CVP(mmHg):10.1±2.6比12.2±3.4,均P<0.05〕.与对照组比较,治疗组7 d总有效率明显升高(90.0％ 比80.0％),ICU住院时间明显缩短(d:8.2±4.5比10.3±2.5),28 d病死率明显降低(20.0％比33.3％),差异均有统计学意义(均P<0.05).结论 PiCCO监测对重症心衰患者进行目标导向性治疗管理,有助于个体化、精准化治疗,缩短ICU住院时间,改善短期预后.

abstractsObjective To investigate the value of pulse indicator continuous cardiac output (PiCCO) monitoring in the treatment management of patients with severe heart failure. Methods Sixty patients of severe heart failure admitted to intensive care unit (ICU) of Fujian Provincial Hospital from August 2017 to February 2019 were enrolled, and they were divided into control group and treatment group according to random number table method, with 30 in each group. The treatment group used bedside PiCCO to carry out minimally invasive hemodynamics monitoring, according to the monitoring data target guidance for vasoactive drugs and liquid management. The control group was based only on traditional electrocardiogram (ECG) monitoring and lung sound, urine volume of vasoactive drugs and liquid management. The changes of cardiac index (CI), global end diastolic volume index (GEDVI), extravascular lung water index (EVLWI), systemic vascular resistance index (SVRI), invasive mean arterial pressure (MAP) and central venous pressure (CVP) were observed before and 72 hours after treatment in the treatment group. The 7-day total effective rate, the length of ICU stay and 28-day mortality were compared between the two groups. Results Compared with before treatment, CI and MAP in the treatment group were significantly increased after treatment [CI (mL·s-1·m-2): 53.34±16.67 vs. 35.01±13.34, MAP (mmHg, 1 mmHg = 0.133 kPa): 72.6±10.6 vs. 62.5±10.3, both P < 0.05], GEDVI, EVLWI, SVRI, CVP were significantly decreased [GEDVI (mL/m2): 760.3±90.2 vs. 960.2±110.3, EVLWI (mL/kg): 6.5±1.3 vs. 12.5±6.2, SVRI (kPa·s·L-1·m-2): 297.3±35.1 vs. 434.1±58.8, CVP (mmHg): 10.1±2.6 vs. 12.2±3.4, all P < 0.05]. Compared with the control group, the 7-day total effective rate of the treatment group was significantly higher (90.0％ vs. 80.0％), the length of ICU stay was significantly shorter (days: 8.2±4.5 vs. 10.3±2.5), and the 28-day mortality was significantly lower, with statistically significant difference (all P < 0.05). Conclusion PiCCO monitoring is a goal-oriented treatment management for patients with severe heart failure, which is helpful to individualized accurate treatment, shorten the length of ICU stay and improve short-term prognosis.