Study On The Value Of PiCCO Technique In The Perioperative Period Of Tuberculous Constrictive Pericarditis

Objective To investigate the application value of PiCCO in the perioperative period of tuberculous constrictive pericarditis and provide a new idea for the rapid recovery of tuberculous constrictive pericarditis.Methods A retrospective study was conducted on 76 patients with tuberculous constrictive pericarditis who were diagnosed by the tuberculosis surgery,zhejiang provincial integrated chinese and western medicine hospital from August 2013 to August 2019.The data of perioperative period were collected and the short-term outcome was followed up by telephone.Patients were divided into PiCCO group and traditional treatment group by using PiCCO or not.The indexes of PiCCO hemodynamics,such as cardiac output(CO),cardiac index(CI),intrathoracic vascular volume index(ITBVI),end diastolic volume index(GEVDI),extravascular pulmonary water index(EVLWI),were used to guide the volume management of PiCCO group;the traditional treatment group was used to guide the volume management of heart rate,arterial blood pressure,central venous pressure,urine volume,etc.T-test,chi square test and other statistical methods were used to test the application value of PiCCO in the perioperative period of tuberculous constrictive pericarditis.Logistic regression analysis was used to predict the independent risk factors of postoperative complications of tuberculous constrictive pericarditis,and ROC curve was used to analyze the predictive value of independent risk factors for the occurrence of complications,so as to further clarify which factors PiCCO technology improved the prognosis of patients.Results A total of 67 patients were included,34 in the PICCO group and 33 in the traditional treatment group.Short-term prognostic indicators showed that the PICCO group had less mechanical ventilation time,ICU stay time,extubation time and postoperative hospital stay than the traditional treatment group,and had significant statistical significance(p<0.01).Complication rate:44.11%(15/34)in PICCO group and 54.54%(18/33)in traditional treatment group.The incidence of complications in PICCO group was less than that in traditional treatment group,but there was no statistical significance(p>0.01).Hypoproteinemia and low cardiac output syndrome were the main types of complications.Physicochemical indexes before and after operation showed that lactate,CVP,and cardiac function grading were improved compared with those before operation,with statistical significance(p<0.01).There was no significant difference in BNP and LVEF(p>0.01).Volume-related indicators on the day of surgery showed significant differences in urine volume and fluid infusion volume(p<0.01).There were no significant differences in drainage volume,intraoperative bleeding,operation time,positive inotropic drugs and diuretics(p>0.01).Multivariate logistic regression analysis showed that ICU length of stay(OR=2.449,95%CI:1.274-4.707,p=0.007)and preoperative CVP(OR=1.165,95%CI:1.025-1.326,p=0.02)were independent risk factors for predicting complications.The area under the ROC curve was 0.808(95%CI:0.702-0.913,p<0.01)for predicting postoperative complications in patients with tuberculous constrictive pericarditis undergoing pericardiectomy.The optimal predictive threshold was 3.5 days with 75%sensitivity and 77.1%specificity.The area under the ROC curve of preoperative CVP for predicting postoperative complications in patients with tuberculous constrictive pericarditis undergoing pericardiectomy was 0.668(95%CI:0.536-0.8,p=0.018).The optimal predictive threshold was 25.5 cmH20,with a sensitivity of 71.9%and a specificity of 60%.Conclusion PICCO has a positive guiding role in the perioperative treatment of tuberculous constrictive pericarditis and can improve the prognosis of patients.To provide a new idea for rapid perioperative rehabilitation of tuberculous constrictive pericarditis.