脉搏指示连续心排血量监测在重症心脏病患者术后治疗中的应用价值

摘要

目的:研究脉搏指示连续心排血量(PiCCO)监测在重症心脏病患者术后治疗中的应用价值.方法:选取2015年10月至2017年2月广东省韶关市粤北人民医院收治的重症心脏病术后患者90例,按随机数字表法将其分为对照组和观察组,每组45例.对照组患者术后行常规治疗,观察组患者术后经PiCCO监测指导治疗.比较两组治疗效果以及观察组术后各时间点(术后6h、12h、24 h及48 h)的心功能指数(CFI)、血管外肺水肿指数(EVLWI)、外周血管阻力指数(SVRI)及中心静脉压(CVP),同时检测患者血清脑钠肽(BNP)水平,并分析BNP与各指标的相关性.结果:观察组血管活性药物使用时间、ICU停留时间、机械通气时间、室性心律失常发生率均明显低于对照组(P＜0.05),术后24 h和48 h,观察组的CFI和SVRI水平均明显高于术后6h和12 h(P＜0.01),EVLWI、CVP和血清BNP水平均明显低于术后6h和12 h(P＜0.01);术后12h,观察组的CFI水平明显高于术后6 h(P＜0.01),EVLWI明显低于术后6 h(P＜0.01);Pearson相关性分析显示:血清BNP水平与CFI呈明显负相关关系(r=-4.891,P=0.000),与EVLWI呈明显正相关关系(r=5.628,P=0.000).结论:PiCCO技术能够有效反映重症心脏病术后患者的血流动力学变化,预测患者心功能和并发症,有助于提高临床疗效.%Objective:To study the value of pulse-indicated continuous cardiac output (PiCCO) in the evaluation of severe heart disease.Methods:90 patients with severe heart disease treated in our hospital from October 2015 to February 2017 were selected and randomly divided into a control group and an observation group,with 45 cases in each group.The patients in the control group were treated with routine therapy after operation.The patients in the observation group were treated as the control group with addition of PiCCO monitoring.The cardiac function index (CFI),extravascular pulmonary edema index (EVLWI),peripheral vascular resistance index (SVRI) and central venous pressure (CVP) after 4 h,12 h,24 h,and 48 h of operation were detected.Serum brain natriuretic peptide (BNP) level was measured,and the correlation between BNP level and cardiac function was analyzed.Results:The use of vasoacrive drugs,ICU hospital days,mechanical ventilation time and the incidence ofventricular arrhythmia were significantly lower than those in the control group (P＜0.05).At 24 h and 48 h after operation,the CFI and SVRI in the observation group were significantly higher than those at 4 h and 12 h post-operation,while EVLWI,CVP and serum BNP level were significantly lower (P＜0.01).At 12 h after operation,the CFI in the observation group was notably increased,whereas the EVLWI and serum BNP level were decreased,compared with those at 4 h post-operation (P＜0.01).Pearson correlation analysis showed that the serum BNP level was negatively correlated with CFI (r=-4.891,P=0.000),and positively correlated with EVLWI (r=5.628,P=0.000).Conclusion:PiCCO could effectively reflect the hemodynamic change of patients with severe heart disease,and predict patients' cardiac function and complications,which might help to improve the therapeutic effect.