两种输液方式在急性心肌梗死急诊介入治疗术中补液效果

The fluid infusion effect of two intravenous infusion methods in emergency interventional therapy for acute myocardial infarction

目的观察单位时间内不同补液量在急性下壁/后壁/右室心肌梗死患者行经皮冠状动脉介入治疗(PCI)时的应用效果。方法选择2016年12月至2018年9月急性下壁/后壁/右室心肌梗死行PCI手术的患者82例,入介入手术室后随机分成观察组(41例),对照组(41例),观察组60 min内补充0.9%NaCl溶液1500 mL。对照组60 min内补充0.9%NaCl溶液500 mL。比较两组血压、心率、血氧饱和度、球囊开通后心源性休克及急性肺水肿等并发症发生率、血管活性药物使用和追加补液情况。结果两组患者补液前血压、心率、血氧饱和度比较差异无统计学意义(P>0.05),球囊开通后10 min,观察组血压、心率均高于对照组,差异有统计学意义(P<0.05),球囊开通后30 min,观察组血压高于对照组,差异有统计学意义(P<0.05)。并发症发生率、血管活性药物使用率、追加补液率对照组均显著高于观察组,差异有统计学意义(P<0.05)。结论急性下壁/后壁/右室心肌梗死PPCI患者在血压、心率、血氧饱和度综合指标监测下,60 min内输注0.9%NaCl溶液1500 mL是安全的,效果优于60 min内输注0.9%NaCl溶液500 mL,有助于及时防治此类PPCI患者血管开通后的低血压状态,利于血管活性药物的合理使用,且减少相关并发症发生。

Objective To evaluate the clinical effect of different fluid infusion volume per unit time in emergency percutaneous coronary intervention(PCI)in patients with acute inferior wall/posterior wall/right ventricular myocardial infarction.Methods A total of 82 patients with acute inferior wall/posterior wall/right ventricular myocardial infarction,who received EPCI during the period from December 2016 to September 2018 at authors'hospital,were enrolled in this study.The patients were randomly divided into the study group(n=41)and the control group(n=41).For the patients of the study group 1500 mL of 0.9%NaCl solution was intravenously infused within 60 minutes,while for the patients of the control group 500 mL of 0.9%NaCl solution was intravenously infused within 60 minutes.The blood pressure,heart rate,oxygen saturation of blood,incidence of complications such as cardiogenic shock and acute pulmonary edema after vascular recanalization with balloon dilatation,use of vasoactive drugs,and additional use of fluid infusion were compared between the two groups.Results Before fluid infusion no statistically significant differences in blood pressure,heart rate and oxygen saturation of blood existed between the two groups(P>0.05).Ten minutes after vascular recanalization with balloon dilatation,the blood pressure and heart rate in the study group were higher than those in the control group,and the differences between the two groups were statistically significant(P<0.05).Thirty minutes after vascular recanalization with balloon dilatation,the blood pressure of the study group was higher than that of the control group,and the difference was statistically significant(P<0.05).The incidence of complications,the frequency of using vasoactive drugs,and the additional use rate of fluid infusion in the control group were remarkably higher than those in the study group,the differences between the two groups were statistically significant(P<0.05).Conclusion In treating patients with acute inferior wall/posterior wall/right ventricular myocardial infarction by using PCI therapy under comprehensive monitoring of blood pressure,heart rate and oxygen saturation of blood,the intravenous infusion of 1500 mL of 0.9%NaCl solution within 60 minutes is clinically safe,its therapeutic effect is superior to intravenous infusion of 500 mL of 0.9%NaCl solution within 60 minutes,which is helpful for timely preventing and curing the hypotension state after vascular recanalization in this kind of patients receiving EPCI,for the rationally using vasoactive drugs,and for effectively reducing the incidence of related complications.