Study On The Relationship Between PiCCO And Swan - Ganz Catheter Hemodynamics And The Effect Of Heart Failure Mixture On PiCCO Hemodynamics Monitoring Index In Patients With Acute Heart Failure

Objectives:To evaluate the hemodynamic indexes ((CI、SVRI、SVI、LVSWI) relevance of PiCCO and Swan-Ganz and the effct of heart failure mixtur on PiCCO haemodynamic indexes((CI、SVRI、SVI、LVSWI) in patients with acute heart failure.Methods:By the means of prospective and stochastic control, according to the inclusion and exclusion criteria, we have collected acute heart failure from April 2014 to April 2015 in Chengdu University of Traditional Chinese Medicine Hospital ICU.According to the random number table method, they were divided into two groups,Swan-Ganz before PiCCO and Swan-Ganz after PiCCO. By the statistical method, we wanted to evaluate the hemodynamic indexes (CI、SVRI、SVI、LVSWI) relevance of PiCCO and Swan-Ganz. At the same time,we have collected 46 cases of acute heart failure,23 cases for the experience group and The control group from January in Chengdu University of Traditional Chinese Medicine Hospital ICU. The control group only treated with western medicine conventional therapy. The experience group additionally received the heart failure mixtur(Heart failure mixtur composition:Bupleurum (柴胡) 25g, Raw oysters (牡蛎) 30g, Chinses Angelica(当 归) 20g,Rhizome of Chuanxiong (川芎) 15g, Radix Rehmanniae (生地黄) 20g, Radix Paeoniae Alba (白芍) 15g,Cortex Acanthopanacis giraldii(红毛五加皮) 50g,Semen Ziziphi Spinosae (酸枣仁) 50g,Panax ginseng(生晒参) 20g, Cinnamon(肉桂)10g, add 2000ml of water, decoct with water, juice of 200ml,50 ml Oral,4 times a day, for 3 days). After treatment PiCCO haemodynamic indexes cardiac index as monitor starting time spot. Repeated haemodynamic measurements were done at baseline then at 24,48 and 72 hours, Stroke volume Index(SVI), Systemic vascular resistance index(SVRI), Left ventricular stroke work index (LVSWI) were determined at each time point. And the 28-day mortality was recorded.Results:(1) In the Swan-Ganz before PiCCO group, the pearson correlation coefficient of CI form Swan-Ganz and PiCCO were 0.674。The pearson correlation coefficient of SVI form Swan-Ganz and PiCCO were 0.756。The pearson correlation coefficient of SVRI were 0.879。The pearson correlation coefficient of LVSWI were 0.752。There was no signficant difference among them(P<0.05),and they were positive linear correlation.(2) In the Swan-Ganz after PiCCO group, the pearson correlation coefficient of CI form Swan-Ganz and PiCCO were 0.753。The pearson correlation coefficient of SVI form Swan-Ganz and PiCCO were 0.826。The pearson correlation coefficient of SVRI were 0.920. The pearson correlation coefficient of LVSWI were 0.838。There was no signficant difference among them(P<0.05),and they were positive linear correlation.(3) In the Swan-Ganz before PiCCO group agreement analysis of Swan-Ganz and PiCCO,the CI differences between two methods is-1.65L/(min-m2), and the limits of agreement is-4.07～0.77L/(min·m). So the two methods Can be used interchangeably within the consistency range ±0.492 L/(min·m2).The SVI differences between two methods is -21.4 ml/m, and the limits of agreement is-45.80-3.00 ml/m2. So the two methods Can be used interchangeably within the consistency range ±4.078 ml/m2. The SVRI differences between two methods is 1110 dyn·s·m2/cm5, and the limits of agreement is -1743～2975 dyn·s·m2/cm5. So the two methods Can be used interchangeably within the consistency range ±560.8 dyn·s·m2/cm5. The LVSWI differences between two methods is -18.88 g·m/m2, and the limits of agreement is -53.88～16.12 g·m/m2. So the two methods Can be used interchangeably within the consistency range ±4.728 g·m/m2.(4)In the Swan-Ganz after PiCCO group agreement analysis of Swan-Ganz and PiCCO,the CI differences between two methods is -1.89 L/(min·m2), and the limits of agreement is -5.49～0.71 L/(min·m2). So the two methods Can be used interchangeably within the consistency range ±0.464 L/(min·m2).The SVI differences between two methods is -16.01 ml/m2, and the limits of agreement is 31.71--0.31 ml/m2. So the two methods Can be used interchangeably within the consistency range ±4.45 ml/m2. The SVRI differences between two methods is 557.6 dyn·s·m2/cm5, and the limits of agreement is -1109～3335 dyn·s·m2/cm5. So the two methods Can be used interchangeably within the consistency range ±823.5 dyn·s·m2/cm5. The LVSWI differences between two methods is -17.58 g·m/m2, and the limits of agreement is -48.7～13.54 g·m/m2. So the two methods Can be used interchangeably within the consistency range ±4.878 g·m/m2.(5) Both the Swan-Ganz before PiCCO group and the Swan-Ganz after PiCCO group, the hemodynamic indexes(CI、SVRI、SVI、LVSWI) of Swan-Ganz and PiCCO were positive linear correlation,and Swan-Ganz and PiCCO two methods Can be used interchangeably.(6) Analysis of adverse reaction in the Swan-Ganz before PiCCO group and the Swan-Ganz after PiCCO group:5 cases of hemorrhage of small scope(22.7%),l cases of Arterial puncture(4.55%).(7) Compared with the control group, CI in the experience group was more increased with statistical significance (P<0.05).Within group comparison, CI was increased with statistical significance from the treatment of twenty-fourth hours (P<0.05) in both groups.Comparison between groups,CI had difference without statistical significance(P>0.05)at T0、T24、T48, but it had difference with statistical significance (P<0.05) at T72.(8) Compared with the control group, SVI in the experience group was more increased with statistical significance (P<0.05).Within group comparison, SVI was increased with statistical significance from the treatment of twenty-fourth hours (P<0.05) in both groups.Comparison between groups,SVI had difference without statistical significance(P>0.05)at T0、T24、T48, but it had difference with statistical significance (P<0.05) at T72.(9) Compared with the control group,SVRI in the experience group was more dropped without statistical significance (P>0.05).Within group comparison, SVRI was increased with statistical significance from the treatment of twenty-fourth hours (P<0.05) in both groups.Comparison between groups,SVRII had difference without statistical significance (P>0.05) at T0、T24、T48 and T72.(10) Compared with the control group,LVSWI in the experience group was increased without statistical significance (P>0.05).Within group comparison, LVSWI was increased with statistical significance from the treatment of twenty-fourth hours (P<0.05) in both groups.Comparison between groups,SVRI had difference without statistical significance (P>0.05) at T0、T24、T48 and T72.(11) The 28-day mortality in treatment group was lower than that in control group, but nos tatistical significant difference was found (P>0.05).Concluons:(1)For the patients with acute heart failure, PiCCO and Swan-Ganz had a positive linear relevance and good agreement, the exchange PiCCO and Swan-Ganz was accepted by the clinical;(2)For the patients with acute heart failure,Heart failure mixtur could improve the abnormal hemodynamics significantly.It could increase cardiac output、 stroke volume, but it did not increase left ventricular and decrease the peripheral vascular resistance.