Wu Wei, Xue Yimin, Lin Fenghui, Chen Dewei
The 4th Severe Medical Department Ward, Fujian Provincial Hospital, Fuzhou 350001, Fujian, China. Corresponding author: Wu Wei, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019 Dec;31(12):1535-1537. doi: 10.3760/cma.j.issn.2095-4352.2019.12.020.
To investigate the value of pulse indicator continuous cardiac output (PiCCO) monitoring in the treatment management of patients with severe heart failure.
Sixty patients of severe heart failure admitted to intensive care unit (ICU) of Fujian Provincial Hospital from August 2017 to February 2019 were enrolled, and they were divided into control group and treatment group according to random number table method, with 30 in each group. The treatment group used bedside PiCCO to carry out minimally invasive hemodynamics monitoring, according to the monitoring data target guidance for vasoactive drugs and liquid management. The control group was based only on traditional electrocardiogram (ECG) monitoring and lung sound, urine volume of vasoactive drugs and liquid management. The changes of cardiac index (CI), global end diastolic volume index (GEDVI), extravascular lung water index (EVLWI), systemic vascular resistance index (SVRI), invasive mean arterial pressure (MAP) and central venous pressure (CVP) were observed before and 72 hours after treatment in the treatment group. The 7-day total effective rate, the length of ICU stay and 28-day mortality were compared between the two groups.
Compared with before treatment, CI and MAP in the treatment group were significantly increased after treatment [CI (mL×s×m): 53.34±16.67 vs. 35.01±13.34, MAP (mmHg, 1 mmHg = 0.133 kPa): 72.6±10.6 vs. 62.5±10.3, both P < 0.05], GEDVI, EVLWI, SVRI, CVP were significantly decreased [GEDVI (mL/m): 760.3±90.2 vs. 960.2±110.3, EVLWI (mL/kg): 6.5±1.3 vs. 12.5±6.2, SVRI (kPa×s×L×m): 297.3±35.1 vs. 434.1±58.8, CVP (mmHg): 10.1±2.6 vs. 12.2±3.4, all P < 0.05]. Compared with the control group, the 7-day total effective rate of the treatment group was significantly higher (90.0% vs. 80.0%), the length of ICU stay was significantly shorter (days: 8.2±4.5 vs. 10.3±2.5), and the 28-day mortality was significantly lower, with statistically significant difference (all P < 0.05).
PiCCO monitoring is a goal-oriented treatment management for patients with severe heart failure, which is helpful to individualized accurate treatment, shorten the length of ICU stay and improve short-term prognosis.
探讨脉搏指示连续心输出量（PiCCO）监测在重度心力衰竭患者治疗管理中的价值。
选取2017年8月至2019年2月福建省立医院重症监护病房（ICU）收治的60例重度心力衰竭患者，按随机数字表法分为对照组和治疗组，每组30例。治疗组采用床边PiCCO进行微创血流动力学监测，根据监测数据目标指导血管活性药物及液体管理。对照组仅依据传统心电图（ECG）监测及肺部听诊、尿量进行血管活性药物及液体管理。观察治疗组治疗前及治疗72小时后心脏指数（CI）、全心舒张末期容积指数（GEDVI）、血管外肺水指数（EVLWI）、全身血管阻力指数（SVRI）、有创平均动脉压（MAP）及中心静脉压（CVP）的变化。比较两组7天总有效率、ICU住院时间及28天死亡率。
治疗组治疗后CI和MAP较治疗前显著升高[CI（mL×s×m）：53.34±16.67比35.01±13.34，MAP（mmHg，1 mmHg = 0.133 kPa）：72.6±10.6比62.5±10.3，均P < 0.05]，GEDVI、EVLWI、SVRI、CVP显著降低[GEDVI（mL/m）：760.3±90.2比960.2±110.3，EVLWI（mL/kg）：6.5±1.3比12.5±6.2，SVRI（kPa×s×L×m）：297.3±35.1比434.1±58.8，CVP（mmHg）：10.1±2.6比12.2±3.4，均P < 0.05]。与对照组比较，治疗组7天总有效率显著更高（90.0%比80.0%），ICU住院时间显著更短（天：8.2±4.5比10.3±2.5），28天死亡率显著更低，差异均有统计学意义（均P < 0.05）。
PiCCO监测是重度心力衰竭患者的目标导向性治疗管理方法，有助于个体化精准治疗，缩短ICU住院时间，改善短期预后。
