脉搏轮廓持续心输出量监测在急性左心衰竭治疗中的指导价值

摘要

Objective:To investigate the target directed effects of monitoring with pulse-induced contour cardiac output (PiCCO) in treatment of acute left heart failure (ALHF) by continuous blood purification (CBP). Methods:Twelve Cases (combination group) with ALHF who developed respiratory failure requiring mechanical ventilation were retrospectively analyzed. On the basis of the medical treatment,patients were given CBP under the monitoring of PICCO. APACHE II score, the capacity indicators (ITBVI, GEDVI, EVLWI) and cardiac function index (CFI) were compared before and after treatments. Meanwhile,28-day mortality rate,mechanical ventilation time, time of ICU stay and APACHE H score were compared between patients of combination group and the other fourteen patients (conventional group) with the same disease. Results:APACHE II score was improved after treatments,ITBVI,GEDVI and EVLWI were returned to normal,and CFI was improved in combination group. The mortality rate,mechanical ventilation time,time of ICU stay and APACHE II scores of combination group were superior to those of the conventional group. Conclusions: CBP is an effective means in treatment of ALHF,and PiCCO provides effective guidance for this treatment.%目的:探讨脉搏轮廓持续心输出量(PICCO)在急性左心衰竭的血液净化(CBP)治疗中的目标导向性作用.方法:回顾性研究因急性左心衰竭出现呼吸衰竭需行机械通气的患者12例(联合组),在内科治疗基础上给予PiCCO监测下CBP治疗,比较治疗前后APACHEⅡ评分,容量指标(ITBVI、GEDVI、EVLWI)和心功能指数(CFI).同时将该组患者和因相同疾病进行机械通气治疗的患者14例(常规组)进行比较,比较28d病死率、机械通气时间、住ICU时间,APACHEⅡ评分.结果:联合组在治疗后APACHEⅡ评分改善,ITBVI、GEDVI、EVLWI恢复正常,CFI改善；联合组病死率、机械通气时间、住ICU时间、APACHEⅡ评分均优于常规组.结论:CBP是治疗急性左心衰竭有效方法,而PiCCO为这种治疗提供了有效的指导.