脉搏指示连续心输出量血流动力学监测和临床评估预测的比较分析

目的:探讨临床评估预测血流动力学状态的符合率和脉搏指示连续心输出量(PiCCO)监测血流动力学对临床治疗的指导性。方法:将2008年1月~2011年12月我院重症医学科收治的72例血流动力学不稳定、拟行PiCCO监测的患者进行临床评估,由各级临床医师预测血流动力学状态并选择治疗方案,在得到监测结果后决定是否更改治疗方案。统计临床评估的预测符合率和治疗方案更改率。结果:临床评估预测患者血流动力学参数的符合率为50.2%~71.3%,其中预测血管外肺水指数(EVLWI)的符合率较其他3项参数均显著升高(均P<0.05)。根据PiCCO监测结果,41%医师更改了治疗方案。SOFA评分6~12的患者,临床预测符合率较评分<6和≥12者均显著降低(均P<0.05)。中高级职称医师预测符合率显著高于住院医师(P<0.05),且更少更改治疗方案(P<0.05)。结论:临床评估预测血流动力学状态的符合率较低,PiCCO监测能指导临床医师制定更适合的治疗方案。

Comparison analysis of clinical evaluation with pulse indicator continuous cardiac output monitor in the hemodynamic assessment of critically ill patients

Objective:To investigate the concordance rate of clinical evaluation in hemodynamic status and guidance of pulse indicator continuous cardiac output(PiCCO)monitor in clinical treatment.Methods:A total of 72 hemodynamic unstable cases were evaluated prior to the insertion of the PiCCO catheter.The team of ICU physicians consisting of 2 attending physicians,2 fellows and 2 residents were required to complete a questionnaire to predict the range of key hemodynamic variables for cardiac index,global end-diastolic volume index,systemic vascular resistance index and extravascular lung water index(EVLWI).Additionally,the ICU team was also asked to indicate a plan for therapy based on the predicted hemodynamic profile and decide if alter the predicted therapy plan after the first measurement of hemodynamic variables.Results:The accuracy prediction of hemodynamic variables were 50.2% to 71.3%,among which EVLWI had a higher concordance rate(P<0.05).41% doctors altered their planned therapy according to the result of the PiCCO information.Doctors had more difficulty in accurately predicting hemodynamic values in critical patients which SOFA scored 6~12(P<0.05).The predictions of critical-care attendings and fellows were more accurate than the residents(P<0.05),and less to alter the planned therapy(P<0.05).Conclusion:Clinical evaluation in hemodynamic status of critically ill patients had a lower accuracy,the information obtained by PiCCO often instruct clinical doctors to choose the optimal treatment.