Clinical Application Value Of Ultrasonic Cardiac Output Monitor In The Treatment Of Critically Ill Patients With Low Emission And High Resistance

Objective : To investigate the clinical value of USCOM(ultrasonic cardiac output monitor USCOM)in the treatment of low row and high resistance critically ill patients.Methods:The cardiac function grading,acute physiological and chronic health score,brain natriuretic peptide,left heart ejection fraction,heart rate,average arterial pressure,blood lactic acid,oxygenation index and Brain natriuretic peptide were performed by experienced physicians from January 2016 to June 2018 in the intensive medicine discipline of Qingdao Hai Tzu Medical Group According to the grading method of the New York Cardiology Society.,central venous pressure,USCOM index system analysis selected 82 patients who met the experimental requirements of low-emission resistance,randomly divided into 2 groups,of which USCOM monitoring work by the system training,experienced,professional and technical physicians to complete,each time to do three times to take the average for the initial sieve,the experimenter to provide data.In the control group,40 cases were treated only according to clinical routine monitoring(heart rate,average arterial pressure,blood lactic acid,oxygenation index,Brain natriuretic peptide,central venous pressure),and 42 cases in the Observation group were routinely monitored(heart rate,average arterial pressure,blood lactic acid,oxygenation index,Brain natriuretic peptide,central venous pressure)and dynamic monitoring USCOM index(Cardiac Blood row index,peripheral vascular resistance Index,time spent in cardiac systolic blood injection),comprehensive analysis of patients with anterior load,posterior load,myocardial contractility,peripheral vascular resistance,oxygen transport for patients to carry out a comprehensive assessment,to guide the clinical non-glycoside positive muscle strength drugs,vasodilation drugs,liquid volume,ventilator adjustment and other accurate treatment of patients.The changes of hemodynamics and blood gas analysis indexes,the dosage of vasoactive drugs and the transfer rate and mortality rate of ICU within 28 days were compared between the two groups.Results:(1)?Comparison of hemodynamic and blood gas analysis parameters between observation Group and control group:There was no statistically significant difference in base values between the two groups(HR,MAP,Lac,OI,CVP,CI,Svri,FTc)(all p>0..05).Treatment of 6 Hours: the observation group compared with the control group OI comparison difference is statistically significant(F=5.14 P<0.05)? There were statistically significant differences in the treatment of 12 hours HR,MAP,Lac,OI,CI,SVRI,FTc,BNP(F=2.84~9.87P<0.05)?Treatment 24 hours,48 hours,72 hours: Two groups of HR,MAP,Lac,OI,CVP,CI,SVRI,FTc,BNP comparative differences are statistically significant(F=3.03~86.57 P<0.05).The observation group improved faster than the control group during the whole treatment,and the hemodynamic and blood gas analysis indexes of the observation group were better than those in the control group,and the difference was statistically significant(P<0.05).(2)?The changes of Dobutamine and nitroglycerin pumping speed in the observation group and control group over time were compared:There was no significant difference in pump speed between the two groups in the treatment of 6 hours,12 hours dobutamine and nitroglycerin(F=0.26~1.14 P>0.05).There was a statistically significant difference in pump speed between 24 hours,48 hours,72 hours of Dobutamine and nitroglycerin(F=3.21~3.98P<0.05).The observation group can quickly adjust the effect of improving cardiac output to reduce peripheral vascular resistance as soon as possible,and the drug reduction speed is fast.(3)?The ICU transfer rate was higher in the observation 28 group than in the control group(x2=4.383 P=0.035),and the mortality rate in the observation group was lower than that in the control group(x2=4.082 P=0.043).Therefore,the rate of ICU transfer in the observation group was higher than that in the control group in 28 days,while the mortality rate was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion: Through the dynamic monitoring of hemodynamics in patients with low row and high resistance critically,USCOM can individually and accurately guide clinical treatment,so as to improve cardiac function,reduce the dosage of vasoactive drugs and shorten the time of drug use,reduce the time of ICU and reduce mortality.