Clinical Application Of Pulse Index Continuous Cardiacoutput In Hemodynamic Monitoring In Patients After Cardiac Surgery

Object:Through the clinical application of pulse index continuous cardiacoutput in patients after cardiacsurgery after cardiacsurgery to assess the role of global end -diastolic volume index and extravascular lung water on the fluid management of patients after cardiacsurgery,so as to observe the clinical perspective of PICCO on hemodynamic monitoring postcardiacsurgery.Method:38 patients who underwenit cardiacsurgery admitted in the SICU of The First Affiliated Hospital of Zhejiang University, College of Medicine between April,2010 and february,2008 Ruledoutcriteria:the femoral artery. Puncture or thermaldilution catheter insertion coniraindieations, cardiac shunt or severe cardiac valve insuffieieney. When was transPorted to SICU, PICCO thermodilution catheter was Placed into femoral artery,record CI,SVL,GEDVL,ITBVL,CVP and PaO2/FiO2 at 7 Interval times(4,8,16,24,32,48,72h) postoperation.StatistiealAnalysis:All statistic alanalys is was eomPuted by SPSS16.0software.All data are expressed as meanvalues standard deviations(mean±SD).All hemodynamiec and Volumetric data obtained were analyzed with Thanalysis of varianee for repeated measurements and LSD.Statistical sigaificanee was eonsidered to be at P<0.05. The correlation of GEDI and CI, EVLWI and PaO2/FiO2,ITBVI and EVLWI were analyzed. Results:1. All of the 18 cases were diseharged, did not oeeur complications such as bleeding, infeetion, arrhythmia, thrombosis, limb isehemia because of the catheter placement, removement or occurence during the study Period.2.No significant difference was found between GEDI and CI (r=-0.03, P=0.62). Subgroup was analyzed using a cutoff 850ml/kg of GEDI。A positive correlation was foundsignificantly between GEDI and CI in the subgroup in which GEDI≤850ml/kg (r=0.73, P<0.01), whereas a negative correlation found significantly in GEDI >850ml/kg subgroup (r=-0.20, P<0.01). Thus, GEDI could be a prognostic variable of the preload in patients after cardiacsurgery.3. A significant negative correlation was found between EVLWI and PaO2/FiO2 (r=-0.45, P<0.01). GEDI and EVLWI were found having a significant positive correlation (r=0.58, P<0.01). Subgroup was also analyzed using a cutoff 850ml/kg of GEDI No significant correlation was found in GEDI≤850ml/kg subgroup (r=0.17, P=0.13), while a significant positive correlation was found in GEDI>850ml/kg subgroup (r=0.66, P<0.01).Conclusion:GEDI and EVLWI could be two important variables in fluid management on patients after cardiacsurgery, GEDI was more significantly correlated with CI than CVP, GEDI was more accurately reflact cardiac preload.PICCO will being play a more important role in hemodynamic monitoring of patients after cardiac surgery.