CAJ | 학술논문

目的：探讨PICCO监测技术在冠心病心力衰竭患者中的应用，为冠心病心力衰竭的监测、治疗及评估提供新的手段。方法：采用完全随机方法将60例冠心病心力衰竭患者分为PICCO监测指导的治疗组与采用传统治疗措施的对照组。观察并记录治疗组患者分别在治疗前和治疗后30min、2h、4h和12h时GEDI(全心舒张末期容积指数)、CI(心脏指数)、SVRI(外周血管阻力指数)、EVLWI（血管外肺水指数）的变化；比较两组患者入ICU后第1个24小时，治疗后36小时、2天、5天APACHE II评分；比较治疗组及对照组在治疗前和治疗后24h、48h、72h血清中BNP的变化；比较两组患者住ICU时间与60天死亡率差异；统计两组患者实施治疗以后所出现的不良反应（主要包括低血压、洋地黄中毒、电解质紊乱）例数。结果：治疗组在治疗后30min，GEDI、SVRI和CI即出现改善，2 h后上述指标显著改善，组内比较有统计学意义(P＜0.05)，EVLWI在治疗后12h明显改善，组内比较有统计学意义(P＜0.05)；治疗组在入住ICU后5天的APACHE II评分低于对照组(P＜0.05)，有统计学意义；治疗组中血浆BNP治疗前和治疗后24h、72h三个时间点比较差异显著，治疗72h后两组组间比较差异显著。治疗组ICU住院天数、60天死亡率明显低于对照组，有统计学意义(P＜0.05)；治疗组低血压、电解质紊乱发生率低于传统治疗组(P＜0.05)，有统计学意义。结论：用PICCO监测血流动力学指标可以直接并有效地指导冠心病心力衰竭的诊断和治疗。
목적：탐토PICCO감측기술재관심병심력쇠갈환자중적응용，위관심병심력쇠갈적감측、치료급평고제공신적수단。방법：채용완전수궤방법장60례관심병심력쇠갈환자분위PICCO감측지도적치료조여채용전통치료조시적대조조。관찰병기록치료조환자분별재치료전화치료후30min、2h、4h화12h시GEDI(전심서장말기용적지수)、CI(심장지수)、SVRI(외주혈관조력지수)、EVLWI（혈관외폐수지수）적변화；비교량조환자입ICU후제1개24소시，치료후36소시、2천、5천APACHE II평분；비교치료조급대조조재치료전화치료후24h、48h、72h혈청중BNP적변화；비교량조환자주ICU시간여60천사망솔차이；통계량조환자실시치료이후소출현적불량반응（주요포괄저혈압、양지황중독、전해질문란）례수。결과：치료조재치료후30min，GEDI、SVRI화CI즉출현개선，2 h후상술지표현저개선，조내비교유통계학의의(P＜0.05)，EVLWI재치료후12h명현개선，조내비교유통계학의의(P＜0.05)；치료조재입주ICU후5천적APACHE II평분저우대조조(P＜0.05)，유통계학의의；치료조중혈장BNP치료전화치료후24h、72h삼개시간점비교차이현저，치료72h후량조조간비교차이현저。치료조ICU주원천수、60천사망솔명현저우대조조，유통계학의의(P＜0.05)；치료조저혈압、전해질문란발생솔저우전통치료조(P＜0.05)，유통계학의의。결론：용PICCO감측혈류동역학지표가이직접병유효지지도관심병심력쇠갈적진단화치료。
Objective: Discussion PICOO used in coronary artery disease patients with heart failure,for monitoring,treatment and evaluation to provide new ways and methods.Methods: The 60 cases were randomly divided into PICCO monitoring heart failure patients with coronary heart disease to guide treatment group and traditional treatment of the control group.Treatment groups were observed before treatment and after 30min,2h,4h and 12h when GEDI (heart diastolic volume index),CI (cardiac index),SVRI (peripheral vascular resistance index),EVLWI (extravascular lung water index).The first two groups were compared after a 24 hours into the ICU,36 hours after treatment,two days,five days APACHE II score;compare 24h,48h,change before treatment and after 72h of serum BNP;comparing two groups of patients live time and 60 ICU mortality differences;adverse reaction after the implementation of the statistical treatment of the two groups of patients emerged (including hypotension,digitalis intoxication,electrolyte imbalance) the number of cases.Results:Treatment grouPafter treatment 30min,GEDI,SVRI and CI appears to improve,2 h after the index improved significantly,statistically significant (P<0.05) in the group,EVLWI 12h after treatment significantly improved statistical comparison within groups significance (P<0.05);treatment group than the control group(P<0.05) in the ICU 5 days after admission APACHE II score was statistically significant;24h,72h three treatment groups before and after treatment of plasma BNP significant differences between time points,the difference between the two groups was significantly 72h after treatment.Treatment group ICU length of stay,60 days compared with control group mortality difference was statistically significant (P<0.05);treatment group hypotension,electrolyte imbalance was lower than the conventional treatment group(P<0.05),there are statistically significant.Conclusion:PICCO monitor hemodynamic parameters can be directly and effectively guide the diagnosis and treatment of coronary heart disease heart failure.