PICCO监护联合床旁即时超声对ICU老年急性心力衰竭患者血气、血流动力学指标的影响及临床效能分析OACSTPCD

Objective To investigate the effects of continuous pulse profile temperature dilution cardiac displacement measurement(PICCO)monitoring combined with bedside real-time ultrasound on the blood gas and hemodynamic indexes in elderly patients with acute heart failure in intensive care unit(ICU)and its clini-cal efficacy.Methods One hundred and fifty elderly patients with acute heart failure in Tongchuan Municipal People's Hospital from December 2020 to December 2022 were selected as the study subjects and divided into the control group and observation group according to different monitoring methods,75 cases in each group.The control group routinely used PICCO monitoring,and the observation group additionally used the bedside real-time ultrasound monitoring on the basis of the control group.Both groups received the continuous treat-ment for 72 h.Serum indexes,coagulation situation,blood gas indexes,hemodynamic and cardiac function in-dexes and clinical efficacy before and after treatment were compared between the two groups.Results Serum natriuretic peptides(BNP),troponin I(TnI),Cystatin C(CysC),C-reactive protein(CRP)levels after treat-ment were significantly improved,in which the levels of BNP,TnI,CysC and CRP in the observation group were lower than those in the control group(P＜0.05).After treatment,the oxygenation index,arterial oxygen pressure(PaO2)and central venous oxygen saturation(ScVO2)in the two groups were significantly increased(P＜0.05),and there was no statistically significant difference in the central venous pressure(CVP)between the two groups(P＞0.05).However,the oxygenation index,PaO2 and ScVO2 in the observation group were higher than those in the control group(P＜0.05).After treatment,the cardiac index(CI),cardiac output(CO)and stroke volume(SV)levels in the two groups were significantly increased,while the global end-dias-tolic volume index(GEDI)and systemic vascular resistance index(SVRI)levels were significantly decreased,moreover the CI,CO and SV levels in the observation group were higher than those in the control group,while the GEDI and SVRI levels were lower than those in the control group,and the differences were statistically significant(P＜0.05).After treatment,the activated partial thromboplatin time(APTT),thrombin time(TT)and D-Dimer(D-D)levels were in the two groups were reduced(P＜0.05),moreover the shortening/decreasing degree in the observation group was higher(P＜0.05).The recurrence rate of heart failure in ICU,machinery ventilation time,ICU stay time and change rate of treatment regimen in the observation group were better than those in the control group(P＜0.05),and there was no statistically significant difference in the mortality within 30 d between the two groups(P＞0.05).Conclusion The bedside real-time ultrasound com-bined with PICCO monitoring for elderly patients with acute heart failure in ICU has better clinical monitoring efficacy,can better improve the blood gas,hemodynamic and cardiac function indexes of the patients,and re-duce the frequency of change of treatment regimen.