CAJ | 학술논문

目的探讨脉搏指数连续心输出量(PICCO)监测技术在顽固性心力衰竭患者血流动力学监测中的目标导向性作用.方法选择顽固性心力衰竭患者18例,在中心静脉压监测下行内科治疗,作为常规组;选择顽固性心力衰竭患者18例,PICCO监测下内科治疗,作为PICCO组,比较治疗前后胸腔内血容量指数(ITBVI)、全心舒张末期容积指数(GEDVI)、血管外肺水指数(EVLWI)、心功能指数(CFI)、氨基末端B型钠尿肽前体(NT-proBNP)及左心室射血分数(LVEF).同时与常规组比较28d病死率、辅助通气时间、重症监护时间,APACHEⅡ评分及再次住院率.结果与治疗前相比,PICCO组在治疗后ITBVI[(1 282.6±196.4)、(907.4±78.3) ml/m2,t =8.75,P =0.001]、GEDVI[(1 026.8±92.1)、(715.2±61.8) ml/m2,t =6.48,P =0.003]、EVLWI[(12.9±5.5)、(6.5±1.2) ml/kg,t =2.94,P=0.033]恢复正常,CFI[(3.1 ±0.5)、(4.8±1.3) L/min,t =2.56,P=0.042]、NT-proBNP[(6 438.3±249.5)、(1 371.6±87.5) ng/L,t=5.12,P=0.019]及LVEF[(26.9±3.1)％、(54.3±2.5)％,t=2.62,P=0.040]明显改善;与常规组比较,PICCO组28 d病死率(33.3％、16.7％,x2=4.99,P=0.026)、辅助通气时间[(8.5±2.3)、(3.2±0.8)d,t=24.31,P=0.001]、重症监护时间[(14.9±2.3)、(8.3±2.0)d,t=12.26,P=0.002],APACHEⅡ评分[(23.4±1.3)、(14.7±1.6)分,=9.52,P=0.011]及再次住院率(38.9％、11.1％,x2=5.79,P=0.020)均优于常规组.结论 PICCO为顽固性心力衰竭患者血流动力学监测中的目标导向提供了有效的指导.
목적 탐토맥박지수련속심수출량(PICCO)감측기술재완고성심력쇠갈환자혈류동역학감측중적목표도향성작용.방법 선택완고성심력쇠갈환자18례,재중심정맥압감측하행내과치료,작위상규조;선택완고성심력쇠갈환자18례,PICCO감측하내과치료,작위PICCO조,비교치료전후흉강내혈용량지수(ITBVI)、전심서장말기용적지수(GEDVI)、혈관외폐수지수(EVLWI)、심공능지수(CFI)、안기말단B형납뇨태전체(NT-proBNP)급좌심실사혈분수(LVEF).동시여상규조비교28d병사솔、보조통기시간、중증감호시간,APACHEⅡ평분급재차주원솔.결과 여치료전상비,PICCO조재치료후ITBVI[(1 282.6±196.4)、(907.4±78.3) ml/m2,t =8.75,P =0.001]、GEDVI[(1 026.8±92.1)、(715.2±61.8) ml/m2,t =6.48,P =0.003]、EVLWI[(12.9±5.5)、(6.5±1.2) ml/kg,t =2.94,P=0.033]회복정상,CFI[(3.1 ±0.5)、(4.8±1.3) L/min,t =2.56,P=0.042]、NT-proBNP[(6 438.3±249.5)、(1 371.6±87.5) ng/L,t=5.12,P=0.019]급LVEF[(26.9±3.1)％、(54.3±2.5)％,t=2.62,P=0.040]명현개선;여상규조비교,PICCO조28 d병사솔(33.3％、16.7％,x2=4.99,P=0.026)、보조통기시간[(8.5±2.3)、(3.2±0.8)d,t=24.31,P=0.001]、중증감호시간[(14.9±2.3)、(8.3±2.0)d,t=12.26,P=0.002],APACHEⅡ평분[(23.4±1.3)、(14.7±1.6)분,=9.52,P=0.011]급재차주원솔(38.9％、11.1％,x2=5.79,P=0.020)균우우상규조.결론 PICCO위완고성심력쇠갈환자혈류동역학감측중적목표도향제공료유효적지도.
Objective To investigate the clinical application of pulse indicator continuous cardiac output (PICCO) target oriented role monitoring technique on hemodynamics in patients with intractable heart failure.Methods Eighteen patients with intractable heart failure were selected as control group and received regular treatment including internal medicine under monitoring by central venous pressure.Another 18 patients with refractory heart failure were selected as PICCO group and given the internal medicine under PICCO monitoring.Intrathoracic blood volume index(ITBVI),global end diastolic volume index(GEDVI),extravascular lung water index (EVLWI),cardiac index (CFI),N-terminal B type natriuretic peptide precursor(NT-proBNP) and left ventricular ejection fraction(LVEF) were recorded.The data including mortality rate,ventilation time,intensive care time,APACHE Ⅱ score and the re-hospitalization rate were also record at 28th day.Results Compared with before treatment,ITBVI,GEDVI,EVLWI in PICCO group were (1 282.6 ± 196.4) ml/m2,(1 026.8 ±92.1) ml/m2,(12.9 ± 5.5) ml/kg respectively,significant different from that before treatment ((907.4±78.3) ml/m2,t =8.75,P =0.001; (715.2 ±61.8) ml/m2,t =6.48,P =0.003; (6.5 ± 1.2)ml/kg),t =2.94,P =0.033) and they are all back to normal level.The indices of CFI,NT-proBNP,LVEF in PICCO group were improved than before treatment (CFI:(3.1 ±0.5) L/min vs.(4.8 ± 1.3) L/min,t =2.56,P=0.042) ;NT-proBNP:(6 438.3 ±249.5) ng/L vs.(1 371.6 ±87.5) ng/L,t =5.12,P =0.019) ;LVEF:(26.9±3.1)％ vs.(54.3 ±2.5)％,t =2.62,P =0.040)).Mortality at 28th D in PICCO group was 16.7％,lower than that of control group (33.3％,x2 =4.99,P =0.026).The indices of assisted ventilation time,intensive care time,APACHE score of lⅡ and the rehospitalization ratein PICCO group were better than that of the control group ((8.5 ±2.3) dvs.(3.2±0.8) d,t=24.31,P＜0.05;(14.9±2.3) dvs.(8.3 ±2.0)d,t=12.26,P=0.002;(23.4±1.3) vs.(14.7±1.6),t=9.52,P=0.011;38.9％ vs.11.1％; t=5.79,P =0.020).Conclusion PICCO provides effective guidance for intractable heart failure patients hemodynamic monitoring of goal orientation.