脉搏指示连续心排血量监测在急性心肌梗死合并心源性休克治疗中的作用

目的 探讨脉搏指示连续心排血量监测(PICCO)在急性心肌梗死合并心源性休克治疗中的作用.方法 选取2014年6月至2016年12月期间广西贵港市人民医院收治的急性心肌梗死合并心源性休克患者共60例,按入院时间分成对照组和观察者组,每组各30例.对照组行中心静脉压(CVP)测定后进行指导治疗,观察组行PICCO及CVP测定后进行指导治疗,收集并记录两组患者在24 h内的总输液量、尿量、N-末端脑钠肽前体(NT-proBNP)值、心脏指数(CI)、左心室射血分数(LVEF)、乳酸值(Lac)、氧合指数(PaO2/FiO2)及28 d病死率指标.结果 两组入院时NT-proBNP、CI、LVEF差异无统计学意义,观察组24 h内的NT-proBNP值为(2591.0±1257.8)ng·L-1(P=0.038)和28 d病死率为50.0%(P=0.032),均较对照组的(3048.0±1640.3)ng·L-1和76.7%明显降低(均P<0.05),同时两组24 h内总输液量(P=0.003)、尿量(P<0.001)、CI(P=0.033)及LVEF(P=0.008)均升高,均差异有统计学意义(P<0.05),而乳酸值(P=0.486)及PaO2/FiO2(P=0.796)两组间比较差异无统计学意义(P>0.05).结论 PICCO在急性心肌梗死合并心源性休克患者的治疗中具有重要的指导作用,有助于早期血流动力学、组织灌注及氧代谢的改善,进而降低了急性心肌梗死合并心源性休克患者的病死率.

Role of pulse indicator continuous cardiac output monitoring in the treatment of acute myocardial infarction with cardiogenic shock

Objective To investigate the role of pulse-indicated continuous cardiac output (PICCO) monitoring in the treatment of a-cute myocardial infarction with cardiogenic shock .Methods A total of 60 patients with acute myocardial infarction combined with car -diogenic shock were selected who were treated in Guigang People 's Hospital of Guangxi from June 2014 to December 2016.According to admission time,they were assigned into control group and observation group ,30 cases in each group.The control group was treated with central venous pressure (CVP) for guidance and treatment,while the observation group was treated with PICCO and CVP for guidance . The total infusion volume,urine volume,N-terminal natriuretic peptide (NT-proBNP) value,cardiac index (CI),left ventricular ejec-tion fraction (LVEF),lactate value (Lac),oxygenation index (PaO2 /FiO2 ) within 24 h and 28-day fatality rate of the two groups of patients were collected and recorded .Results Compared with the control group (3048.0 ±1640.3) ng· L-1 ) and 76.7%],the NT-proBNP was (2591.0 ±1257.8) ng· L-1 ] value (P =0.038) and the 28-day fatality rate was 50.0%(P =0.032) in the ob-servation group were significantly lower ,and the differences were statistically significant (P <0.05).Meanwhile,the total infusion vol-ume (P =0.003),urine volume (P <0.001),CI (P =0.033) and LVEF (P =0.008) were increased within 24h,and the differences were statistically significant (P <0.05).There were no significant differences in lactic acid value (P =0.486) and PaO2 /FiO2 (P =0.796) (P >0.05).Conclusions PICCO plays an important role in the treatment of patients with acute myocardial infarction and cardiogenic shock.It is helpful to the improvement of early hemodynamics ,tissue perfusion and oxygen metabolism,thereby reducing the mortality of patients with acute myocardial infarction combined with cardiogenic shock .