PiCCO与Swan-Ganz在急性下壁心肌梗死患者中血流动力学监测比较

摘要

目的：比较脉搏指示连续心排量监测（PiCCO）与Swan-Ganz监测在急性下壁心肌梗死补液治疗的指导作用。方法选择解放军总医院心脏重症监护室（CCU）从2013年1月~2015年1月收治的急性下壁心肌梗死患者32例，男性22例，女性10例，年龄41~82（62.96±11.40）岁。通过补液治疗比较两种方法测得的心排量（CO），观察CO、中心静脉压（CVP）和肺毛细血管楔压（PCWP）随补液量的变化情况，CVP、全心舒张末期容积指数（GEDI）与血管外肺水指数（EVLWI）的关系。结果在本研究设定的补液范围内，两种监测方法补液前后的CO对比，差异无统计学意义（P均＞0.05）。两种方法监测的血流动力学关键指标（CO）结果一致。Swan-Ganz测定的CVP与PiCCO测定的EVLWI无相关性（r=0.143，P＞0.05），PiCCO测定的GEDI与EVLWI呈正相关（r=0.769，P＜0.001）。结论两种方法监测的血流动力学关键指标CO结果一致，Swan-Ganz方法准确，但需经过右心系统操作难度大，并发症高；PiCCO不经过右心，创伤较小，操作相对简单，能够提供实时、动态、较多的血流动力学参数。%Objective To compare the guiding effects of pulse indicator continuous cardiac output (PiCCO) monitoring and Swan-Ganz monitoring in rehydration treatment in patients with acute inferior wall myocardial infarction.Methods The patients (n=32, male 22, female 10, aged from 41 to 82 and average age=62.96±11.40) were chosen from Jan. 2013 to Jan. 2015. Through rehydration treatment, the cardiac output (CO) was compared between 2 monitoring methods, and the changes of CO, central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) as the variation of fluid supplement volume were observed. The relationship among CVP, global end-diastolic volume index (GEDI) and extravascular lung water index (EVLWI) were observed.Results Within the set range of fluid supplement volume, the difference in CO comparison between 2 monitoring methods had no statistical significance before and after rehydration treatment (allP>0.05). The hemodynamic key index (CO) monitored by 2 methods had the same results. There was no correlation between CVP monitored by Swan-Ganz and EVLWI monitored by PiCCO (r=0.143,P>0.05), and GEDI detected by PiCCO was positively correlated to EVLWI detected by PiCCO (r=0.769,P<0.001).Conclusion The hemodynamic key index (CO) monitored by 2 methods had the same results. Swan-Ganz monitoring is more accurate but has more difficulty in operation with more complications because of trans-right cardiac system. PiCCO is easier in operation with fewer injuries because of non trans-right cardiac system, which can provide more real time and dynamic hemodynamic parameters.