Clinical application of pulse indicator continuous cardiac output monitoring on hemodynamics in patients with intractable heart failure / 中国综合临床

ABSTRACT

Objective To investigate the clinical application of pulse indicator continuous cardiac output (PICCO) target oriented role monitoring technique on hemodynamics in patients with intractable heart failure.Methods Eighteen patients with intractable heart failure were selected as control group and received regular treatment including internal medicine under monitoring by central venous pressure.Another 18 patients with refractory heart failure were selected as PICCO group and given the internal medicine under PICCO monitoring.Intrathoracic blood volume index(ITBVI),global end diastolic volume index(GEDVI),extravascular lung water index (EVLWI),cardiac index (CFI),N-terminal B type natriuretic peptide precursor(NT-proBNP) and left ventricular ejection fraction(LVEF) were recorded.The data including mortality rate,ventilation time,intensive care time,APACHE Ⅱ score and the re-hospitalization rate were also record at 28th day.Results Compared with before treatment,ITBVI,GEDVI,EVLWI in PICCO group were (1 282.6 ± 196.4) ml/m2,(1 026.8 ±92.1) ml/m2,(12.9 ± 5.5) ml/kg respectively,significant different from that before treatment ((907.4±78.3) ml/m2,t =8.75,P =0.001; (715.2 ±61.8) ml/m2,t =6.48,P =0.003; (6.5 ± 1.2)ml/kg),t =2.94,P =0.033) and they are all back to normal level.The indices of CFI,NT-proBNP,LVEF in PICCO group were improved than before treatment (CFI(3.1 ±0.5) L/min vs.(4.8 ± 1.3) L/min,t =2.56,P=0.042) ;NT-proBNP(6 438.3 ±249.5) ng/L vs.(1 371.6 ±87.5) ng/L,t =5.12,P =0.019) ;LVEF(26.9±3.1)％ vs.(54.3 ±2.5)％,t =2.62,P =0.040)).Mortality at 28th D in PICCO group was 16.7％,lower than that of control group (33.3％,x2 =4.99,P =0.026).The indices of assisted ventilation time,intensive care time,APACHE score of lⅡ and the rehospitalization ratein PICCO group were better than that of the control group ((8.5 ±2.3) dvs.(3.2±0.8) d,t=24.31,P＜0.05;(14.9±2.3) dvs.(8.3 ±2.0)d,t=12.26,P=0.002;(23.4±1.3) vs.(14.7±1.6),t=9.52,P=0.011;38.9％ vs.11.1％; t=5.79,P =0.020).Conclusion PICCO provides effective guidance for intractable heart failure patients hemodynamic monitoring of goal orientation.