PiCCO指导左心功能低下冠状动脉旁路移植患者围术期治疗的研究

目的 探讨脉搏指示连续心排血量(PiCCO)技术在术前左心功能低下(LVEF<50％)的重症冠心病(CAHD)行冠状动脉旁路移植术(CABG)围术期治疗中的应用价值及指导意义.方法 选择2017年1月～2018年12月于新疆心脑血管病医院在体外循环下行择期CABG治疗的CAHD患者80例,随机分为PiCCO组和对照组,...

A randomized controlled study of PiCCO technology in guiding the perioperative treatment of patients undergoing coronary artery bypass grafting with preoperative left heart function hypofunction

Objective To explore the application value and guiding significance of the pulse-indicating continuous cardiac output(PiCCO)technology in the perioperative treatment of severe coronary heart disease with preoperative left heart function(LVEF<50%)and coronary artery bypass grafting(CABG).Methods From January 2017 to December 2018,80 patients with CAHD who underwent elective CABG surgery under cardiopulmonary bypass were selected and randomly divided into PiCCO group and control group,with 40 cases in each group.The PiCCO group received volume management and vasoactive drug management based on the relevant data of PiCCO catheter monitoring,and the control group received empirical treatment based on routine monitoring of mean arterial pressure(MAP)and central venous pressure(CVP).Results The mechanical ventilation time,ICU time and postoperative hospitalization time of patients in the PiCCO group were significantly lower than those in the control group,and the differences were statistically significant(P=0.01,P=0.02,P=0.04,respectively).In the PiCCO group,GEDI,SVRI,CI and EVLWI all improved after 6 hours of treatment,and the comparison within the group was statistically significant(all P<0.05).Compared with before treatment,BNP levels in the two groups of patients were significantly reduced 24 h,72 h after treatment and when they were out of ICU,and the difference was statistically significant(P<0.05).The amount of vasoactive drugs in the PiCCO group was significantly lower than that in the control group(P=0.01,P=0.04,respectively).There was no death during the hospitalization of the two groups of patients after the operation,and there was no significant difference in the incidence of serious postoperative complications(P>0.05).Conclusion For severe coronary heart disease with low left ventricular function(LVEF<50%)before operation,PiCCO technology is used to monitor hemodynamic indicators and guide treatment after CABG,which can stabilize circulation,reduce pulmonary edema,and improve tissue perfusion with certain degree of safety and effectiveness.