连续血流动力学监测技术在机械通气患者中的应用研究

目的 通过对机械通气患者进行Swan-Ganz肺动脉热稀释法、脉搏轮廓动脉压波形分析法（PiCCO）及部分CO2重复呼吸法（无创心排血量监测，NICO）连续血流动力学监测。阐述3种监测技术的相关性。方法 13例各种原因导致呼吸衰竭行机械通气的患者，每例患者均同时行Swan-Ganz、PiCCO、NICO监测，在治疗手段及呼吸机设置条件相同的情况下，于同一时间点采集3种监测方法的血流动力学数据，比较3种监测技术的相关性。结果 相关分析显示。在各种方法所测心排血指数（CI）间PiCCO与Swan-Ganz相关系数为0．883。NICO与Swan-Ganz相关系数为0．853，PiCCO与NICO相关系数为0．857，PiCCO、NICO均与Swan-Ganz有较好的相关性。结论 PiCCO及NICO连续血流动力学监测可作为重症监护室（ICU）机械通气患者床旁监测的可靠手段，从而进一步指导制订有效的治疗策略。

Study of continuous hemodynamics monitoring techniques in patients with mechanical ventilation

OBJECTIVE: To elucidate the relativity among three kinds of continuous hemodynamics monitoring techniques: thermodilution via Swan-Ganz catheter, pulse contour analysis method (PiCCO), partial CO(2) rebreathing method (non invasive cardiac output, NICO), in patients with mechanical ventilation. METHODS: In 13 patients with respiratory failure due to different causes, hemodynamics were continuously monitored with Swan-Ganz catheterization, PiCCO, NICO simultaneously. The therapeutic measures and the type of ventilator were similar. Data were collected at the same time points to compare the relativity among these three kinds of monitor. RESULTS: Linear relative analysis showed a good relativity in PiCCO/Swan-Ganz (r=0.883), NICO/Swan-Ganz (r=0.853) and PiCCO/NICO (r=0.857) in cardiac index (CI). CONCLUSION: PiCCO and NICO can be used as reliable measure to monitor ventilated patients bedside in intensive care unit (ICU), thus offering an assistance to optimize therapeutic strategy.