广西医学
廣西醫學
엄서의학
GUANGXI MEDICAL JOURNAL
2015年
2期
182-185
,共4页
韦妍飞%曹莉%刘燕%张黎%盘璇
韋妍飛%曹莉%劉燕%張黎%盤璇
위연비%조리%류연%장려%반선
心力衰竭%脉搏指示连续心排血量%胸腔内血容积指数%血管外肺水指数%中心静脉压%系统血管阻力指数%心脏指数
心力衰竭%脈搏指示連續心排血量%胸腔內血容積指數%血管外肺水指數%中心靜脈壓%繫統血管阻力指數%心髒指數
심력쇠갈%맥박지시련속심배혈량%흉강내혈용적지수%혈관외폐수지수%중심정맥압%계통혈관조력지수%심장지수
Heart failure%Pulse-indicated continuous cardiac output%Intrathoracic blood volume index%Extravascular lung water index%Central venous pressure%Systemic vascular resistance index%Cardiac index
目的：探讨脉搏指示连续心排血量监测（ PiCCO）技术在重度心力衰竭患者治疗中的应用效果。方法将60例重度心力衰竭患者按随机数字法分为治疗组与对照组，各30例。治疗组采用PiCCO 技术监测血流动力学指标：心脏指数（ CI）、胸腔内血容积指数（ ITBVI）、血管外肺水指数（ EVLWI）、系统血管阻力指数（ SVRI）等指导液体管理及血管活性药物应用；对照组根据中心静脉压（ CVP）变化指导治疗。比较两组患者机械通气时间、ICU住院时间、治疗后28 d病死率的不同；观察治疗组治疗前后CI、ITBVI、EVLWI、SVRI的变化；观察治疗组死亡与存活患者治疗前及治疗3 d后EVLWI的变化。结果治疗组机械通气时间、ICU住院时间、治疗后28 d病死率均低于对照组（ P＜0．05）；治疗组治疗后ITBVI、EVLWI、SVRI恢复正常，与治疗前比较差异有统计学意义（P＜0．05），CI改善与治疗前比较，差异有统计学意义（P＜0．05）；治疗组患者死亡7例，存活23例；治疗组存活与死亡患者治疗前EVLWI水平比较，差异无统计学意义（P＞0．05）；存活患者治疗3天后EVLWI水平明显低于治疗前，且明显低于死亡患者（P＜0．05）。结论利用PiCCO监测指标指导重度心力衰竭治疗，可改善患者心功能，减少机械通气时间及ICU住院时间，降低病死率；动态观察EVLWI可评估患者预后。
目的：探討脈搏指示連續心排血量鑑測（ PiCCO）技術在重度心力衰竭患者治療中的應用效果。方法將60例重度心力衰竭患者按隨機數字法分為治療組與對照組，各30例。治療組採用PiCCO 技術鑑測血流動力學指標：心髒指數（ CI）、胸腔內血容積指數（ ITBVI）、血管外肺水指數（ EVLWI）、繫統血管阻力指數（ SVRI）等指導液體管理及血管活性藥物應用；對照組根據中心靜脈壓（ CVP）變化指導治療。比較兩組患者機械通氣時間、ICU住院時間、治療後28 d病死率的不同；觀察治療組治療前後CI、ITBVI、EVLWI、SVRI的變化；觀察治療組死亡與存活患者治療前及治療3 d後EVLWI的變化。結果治療組機械通氣時間、ICU住院時間、治療後28 d病死率均低于對照組（ P＜0．05）；治療組治療後ITBVI、EVLWI、SVRI恢複正常，與治療前比較差異有統計學意義（P＜0．05），CI改善與治療前比較，差異有統計學意義（P＜0．05）；治療組患者死亡7例，存活23例；治療組存活與死亡患者治療前EVLWI水平比較，差異無統計學意義（P＞0．05）；存活患者治療3天後EVLWI水平明顯低于治療前，且明顯低于死亡患者（P＜0．05）。結論利用PiCCO鑑測指標指導重度心力衰竭治療，可改善患者心功能，減少機械通氣時間及ICU住院時間，降低病死率；動態觀察EVLWI可評估患者預後。
목적：탐토맥박지시련속심배혈량감측（ PiCCO）기술재중도심력쇠갈환자치료중적응용효과。방법장60례중도심력쇠갈환자안수궤수자법분위치료조여대조조，각30례。치료조채용PiCCO 기술감측혈류동역학지표：심장지수（ CI）、흉강내혈용적지수（ ITBVI）、혈관외폐수지수（ EVLWI）、계통혈관조력지수（ SVRI）등지도액체관리급혈관활성약물응용；대조조근거중심정맥압（ CVP）변화지도치료。비교량조환자궤계통기시간、ICU주원시간、치료후28 d병사솔적불동；관찰치료조치료전후CI、ITBVI、EVLWI、SVRI적변화；관찰치료조사망여존활환자치료전급치료3 d후EVLWI적변화。결과치료조궤계통기시간、ICU주원시간、치료후28 d병사솔균저우대조조（ P＜0．05）；치료조치료후ITBVI、EVLWI、SVRI회복정상，여치료전비교차이유통계학의의（P＜0．05），CI개선여치료전비교，차이유통계학의의（P＜0．05）；치료조환자사망7례，존활23례；치료조존활여사망환자치료전EVLWI수평비교，차이무통계학의의（P＞0．05）；존활환자치료3천후EVLWI수평명현저우치료전，차명현저우사망환자（P＜0．05）。결론이용PiCCO감측지표지도중도심력쇠갈치료，가개선환자심공능，감소궤계통기시간급ICU주원시간，강저병사솔；동태관찰EVLWI가평고환자예후。
Objective To explore the clinical effect of pulse-indicated continuous cardiac output(PiCCO) technique on the treatment of patients with advanced heart failure .Methods Sixty cases of advanced heart failure were randomly divided into treatment group and control group,with 30 cases in each group .PiCCO technique was adopted to monitor the hemodynamic parameters for the guidance of fluid therapy and vasoactive agents usage in the treatment group .The hemodynamic parameters included cardiac index (CI),intrathoracic blood volume index(ITBVI),extravascular lung water index (EVLWI) and systemic vascular resistance index (SVRI).However,the treatment was performed according to the changes in central venous pressure ( CVP ) in the control group .The mechanical ventilation duration , intensive care unit(ICU) stay,and 28-day mortality after treatment were compared between two groups .The changes in CI,ITBVI,EVLWI and SVRI were observed in the treatment group before and after treatment .The changes in EVLWI of deaths and survivors were observed in the treatment group before and 3 days after treatment .Results The mechanical ventilation duration ,ICU stay,and 28-day mortality after treatment in the treatment group were significantly lower than those in the control group (P<0.05).After treatment,ITBVI,EVLWI,SVRI in the treatment group became normal while CI improved , which showed a significant difference in contrast with those before treatment (P<0.05).There were 7 cases died and 23 cases survived in the treatment group .No significant differences were found in the level of EVLWI between survivors and deaths in the treatment group before treatment (P<0.05),and the level of EVLWI of survivors in 3-day treatment was significantly lower than that before treatment and of deaths (P<0.05).Conclusion The treatment of advance heart failure guided by PiCCO monitoring can improve the patients′heart function,reduce mechanical ventilation duration and ICU stay ,and decrease fatality rate.Dynamic observation on EVLWI can be used to assess the prognosis of these patients .
