PiCCO指导下强化液体管理治疗急性左心衰的临床研究

目的:观察脉搏指示连续心输出量(PiCCO)指导下强化液体管理治疗急性左心衰的疗效。方法:138例急性左心衰患者被随机分为液体管理组(73例)和常规治疗组(65例),以PiCCO监测血流动力学指标:心输出量(CO)、心指数(CI)、胸腔内血管容量指数(ITBVI)、血管外肺水指数(EVLWI)等指导液体管理,测定血浆脑型利钠肽(BNP)、心脏超声测定左室射血分数(LVEF)、左室舒张末期内径(LVEDd)评估心功能,监测动脉血气分析评估肺功能状况。结果:治疗1周后,与常规治疗组相比,液体管理组BNP(3283.98±73.91)pg/ml比(1584.26±64.71)pg/ml]水平明显下降(P<0.05);血流动力学CO(3.47±0.14)L.min-1.m-2比(4.59±0.37)L.min-1.m-2]、CI(3.45±0.24)比(4.68±0.75)]明显升高,EVLWI(7.89±0.74)ml/kg比(5.67±0.21)ml/kg]明显减少(P均<0.05);心脏超声提示LVEF(38.61±1.72)%比(47.22±2.13)%]明显提高,LVEDd(53.51±1.98)mm比(46.74±2.01)mm]明显下降(P均<0.05);液体负平衡量(750.23±24.67)ml比(1248.91±87.49)ml]明显增加(P<0.05);血气分析提示动脉血气氧分压(85.32±14.35)mmHg比(101.43±5.87)mmHg]明显提高,肺泡—动脉氧分压差(15.38±3.61)mmHg比(7.53±3.54)mmHg]明显下降(P均<0.05)。结论:脉搏指示连续心输出量指导下强化液体管理可更有效改善心肺功能,与其精确液体管理有关。

Clinical research of enhanced liquid management by PiCCO guidance in patients with acute left heart failure

Objective：To observe curative effect of enhanced liquid management under guidance of pulse-indicated continuous cardiac output（PiCCO） on acute left heart failure.Methods：A total of 138patients with acute left heart failure were randomly divided into fluid management group（n=73） and routine treatment group（n=65）.Cardiac output（CO）,cardiac index（CI）,intrathoracic blood volume index（ITBVI） and extravascular lung water index（EVLWI） etc.,were monitored by PiCCO to guide liquid management.Plasma brain natriuretic peptide（BNP）,left ventricular ejection fraction（LVEF） and left ventricular end-diastolic dimension（LVEDd） were measured.Arterial blood gas was monitored to assess lung function.Results：Compared with routine treatment group,there was significant decrease in BNP level （3283.98±73.91） pg/ml vs.（1584.26±64.71） pg/ml,P〈0.05 ];There were significant increase in CO （3.47±0.14） L.min^-1.m^-2 vs.（4.59±0.37） L.min^-1.m^-2 ],CI （3.45± 0.24） vs.（4.68±0.75）] and LVEF （38.61±1.72） % vs.（47.22±2.13） % ],and significant decrease in EVLWI （7.89±0.74） ml/kg vs.（5.67±0.21） ml/kg ],LVEDd （59.51±3.01） mm vs.（46.74±2.01） mm ] in fluid management group;There was significant increase in negative liquid balance amount （750.23±24.67） ml vs.（1248.91±87.49） ml ],and arterial partial pressure of oxygen （85.32±14.35） mmHg vs.（101.43±5.87） mmHg ];There was significant decrease in alveolar-arterial oxygen difference （15.38±3.61） mmHg vs.（7.53± 3.54） mmHg ],P〈0.05all in liquid management group.Conclusion：Enhanced fluid management can better improve cardiac and lung function under guidance of pulse-indicated continuous cardiac output,which may be related with accurate and adequate liquid management.