PICCO在肺水肿危重患者中的应用

目的 观察脉搏轮廓温度稀释连续心排血量监测技术（PICCO）在肺水肿危重患者中的应用及效果.方法 采用前瞻性临床观察研究方法,将54例肺水肿危重患者随机分为观察组和对照组,每组27例.观察组采用PICCO对患者血流动力学变化进行监测,并进行早期积极的液体容量管理;对照组行中心静脉导管留置,根据中心静脉压（CVP）指导液体容量管理.比较两组治疗第1、2、3d的血流动力学参数变化、机械通气时间、住ICU时间、APACHEⅡ评分及28 d病死率等.结果 治疗第2、3d,观察组心率（HR）、CVP及心排量指数（CI）与第1d相比显著改善,且HR及CI指标明显优于同一时间对照组（P＜0.05）;治疗第2、3d,观察组全心舒张末期容积指数（GEDVI）、胸腔内血容量指数（ITBVI）及血管外肺水含量指数（EVLWI）与第1d相比均显著改善（P＜0.05）;观察组机械通气时间及住ICU时间明显短于对照组,APACHEⅡ评分明显高于对照组（P＜0.05）;观察组28d内无死亡病例,对照组死亡3例,观察组28d病死率低于对照组,但差异无统计学意义（P＞0.05）.结论 PICCO监测指导肺水肿危重患者早期液体管理,能有效缩短机械通气时间及ICU住院时间,有助于肺水肿危重患者救治.

Application of PICCO to critical patients with pulmonary edema

Objective To discuss the application of pulse indicator continuous cardiac output （PICCO） to critical patients with pulmonary edema and the effect.Methods 54 critical patients with pulmonary edema were randomly divided into 2 groups：observation group and control group,27 in each;PICCO was applied to monitor the hemodynamic changes of the patients in observation group and early positive volume management of fluid was performed,while detained central venous catheter was applied to patients in control group and volume management of fluid was carried out based on central venous pressure（CVP） ;a comparative study was made between the 2 groups on the changes of hemodynamic index,mechanical ventilation time,the time length of staying in ICU,the scores of APACHE Ⅱ and the case fatality rate in 28 days.Results The heart rate （HR）,CVP and cardiac output index （CI） of the patients in observation group on the 2nd and 3rd day of the treatment were much more improved than those on the 1st day and much superior to those of the patients in control group of the same time（P ＜ 0.05） ;the GEDVI,ITBVI and EVLWI of the patients in observation group on the 2nd and 3rd day of the treatment were more improved than those on the 1st day（P ＜ 0.05） ;the mechanical ventilation time and the time length of staying in ICU of the patients in observation group were much shorter than those of the patients in control group while their scores of APACHE Ⅱ were higher than those of the patients in control group （P ＜ 0.05） ; the case fatality rate in observation group in 28 days was lower than that in control group （no death occurred in observation group while 3 patients died in control group） but the difference was of no obvious statistical significance（P ＞ 0.05）.Conclusions The application of PICCO in monitoring the early volume management of fluid in critical patients with pulmonary edema can effectively shorten the mechanical ventilation time and the time length of staying in ICU,which is quite helpf