| Objective: To analyze the influence of clinical data of patients monitored by pulse indicator continuous cardiac output monitoring(PICCO)on the prognosis of patients and the composition of diseases in different hemodynamic states in the department of intensive Care unit of a third-class hospital,so as to provide a theoretical basis for clinical treatment,fluid management and the similarities and differences of hemodynamic states of different diseases.Methods: The clinical date of patients wh o applied PICCO monitoring technology in the Department of intensive Care unit of a third-class hospital from July 2017 to July 2020 were analyzed retrospectively.Then,according to the PICCO data,the patients were divided into high output and low resistance group,low output high resistance group and other groups,and the disease composition and prognosis of each group were compared.According to the prognosis of 7 days and 28 days,the patients were divided into survival group and death group,and the effects of PICCO and other clinical date on the prognosis of 7 days and28 days were analyzed.Results:(1)From July 2017 to July 2020,the Department of intensive Care unit of a third-class hospital used PICCO to monitor 166 patients,aged between 23 and 8 9 years old,61.24±15.04 years old.There were 29 patients with high output and low resistance(17.4%),63 patients with low output and high resistance(37.9%),and 74 patients with other hemodynamic states(44.7%).The main diseases included cardiac insuf ficiency(n = 52),septic shock(n =50),respiratory failure(n = 28)and other diseases(n = 36).There were42 deaths within 7 days,and the 7-day mortality rate was 25.3%.There were 80 deaths within 28 days,and the 28-day mortality rate was 48.1%.The 7-day mortality rate of patients with septic shock was 28%.The28-day mortality rate of patients with septic shock was 44.0%.The7-day mortality rate of patients with cardiac insufficiency was 23%.The28-day mortality rate of patients with cardiac insu fficiency was51.9%.The 7-day mortality rate of patients with respiratory failure was17.8%.The 28-day mortality rate of patients with respiratory failure was 42.8%.The 7-day mortality rate of patients with other disease was30.5%.The 28-day mortality rate of patients with other disease was52.8%.(2)There were 29 cases with high output and low resistance,mainly septic shock(17 cases,58.6%)and respiratory failure(4cases,13.8%).The mortality rate within 7-days in this group was 27.5%,of which the mortality rate of septic shock was 17.6%.There was significant differences in APACHEII,SVV and MAP between death group and survival group within 7-days(P<0.05).The mortality rate within 28-days in this group was 41.3%,of which the mortality rate of septic shock was 35.3%.There was significant differences in APACHEII and MAP between death group and survival groups within28 days(P<0.05).(3)There were 63 cases with low output and high resistance,mainly cardiac insufficiency(31 cases,49.2%),septic shock(8 cases,12.7%)and respiratory failure(9 cases,14.2%).The mortality rate within 7-day in this group was 30.2%,the mortality rate of patients with cardiac insufficiency was 32.2%,and the mortality rate of septic shock was 50%.There was significant diffe rences in APACHEII,Lac and BNP between death group and survival groups within 7 days(P<0.05).The mortality rate within 28-day in this group was 55.6%,the mortality rate of patients with cardiac insufficiency was 58.1%,and the mortality rate of septic shock was 62.5%.There was significant difference in BNP between death group and survival group within 28days(P<0.05).(4)There were 74 cases in other groups,mainly septic shock(25 cases,33.8%),cardiac insufficiency(20 cases,27.0%)and respiratory failure(15 cases,20.3%).The mortality rate within 7-day in this group was 20.3%,the mortality rate of patients with septic shock was 28%,the mortality rate of cardiac insufficiency was 5%,and the mortality rate of respiratory failure was 13.3%.There was significant difference in Lac,PCT,MAP and ELWI between death group and survival group within 7 days(P<0.05).The mortality rate within 28-day in this group was 44.5%,the mortality rate of patients with septic shock was 44%,the mortality rate of cardi ac insufficiency was 40%,and the mortality rate of respiratory failure was 40%.There was significant differences in Lac,ELWI and SVV between death group and survival group within 28 days(P<0.05).(5)The disease constituent ratio was different in different hemodynamic states,and there was statistical significance between the disease constituent ratio(P<0.05).The patients with high output and low resistance group was mainly septic shock,the patients with low output and high resistance group was mainly patients with cardiac insufficiency,and the other groups w as mainly patients with septic shock,cardiac insufficiency and respiratory failure.(6)APACHEII,BNP,Lac and MAP have influence on the survival rates of patients within 7-days and 28-days,and APACHEII,BNP and Lac were independent risk factors affecting the prognosis of 7days and 28 days(P<0.05).APACHEII,Lac and BNP were analyzed by ROC curve,and the results were statistically significant in judging the prognosis of 7-days and 28-days survival rate(P<0.05).The AUC of7-day prognosis judged by Lac was the highest,which was 0.705.ELWI in PICCO is also an independent risk factors for 28-day survival.The AUC for judging the prognosis is 0.648,and the critical value for judging the prognosis is 12.75ml/kg,and its sensitivity and specificity are 0.438 and 0.814 respectively.Conclusions:(1)Patients with ICU have complex and changeable hemodynamic states.Patients with high output and low resistance group are mainly septic shock,while pati ents with low output and high resistance group are mainly patients with cardiac insufficiency caused by various reas ons.(2)The hemodynamic of each disease is diverse,and different hemodynamic states can reflect th occurrence and development of the dise ase.(3)The commonly used APACHEII score scale,BNP,PCT,Lac and ELWI are of great significance in judging the severity of the disease and predicting the prognosis of the patients. |
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