脉搏指数连续心输出量监测在急性心肌梗死合并心源性休克患者治疗中的临床应用

Clinical application of continuous cardiac output monitoring with pulse index in the treatment of acute myocardial infarction complicated with cardiogenic shock

目的探讨脉搏指数连续心输出量(PICCO)监测在急性心肌梗死(AMI)合并心源性休克(CS)患者治疗中的临床应用。方法选取2015年2月~2018年10月湖北省孝感市中心医院收治的AMI合并CS患者107例,根据随机数字表法将患者分为非PICCO组(53例)和PICCO组(54例),非PICCO组给予常规监测治疗,PICCO组在PICCO指导下治疗。比较两组患者临床效果(血管活性药物使用时间、住院时间、机械通气时间、病死率);PICCO组治疗24、48、72 h后心脏指数(CI)、血管外肺水指数(EVLWI)、胸腔内血容量指数(ITBVI)、全心舒张末期容量指数(GEDVI);两组治疗24、48 h后高敏肌钙蛋白(hs-cTnI)、N端前脑钠肽(NT-proBNP)、急性生理和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分变化情况。结果PICCO组患者血管活性药物使用时间、住院时间、机械通气时间均短于非PICCO组,PICCO组病死率明显低于非PICCO组,差异有统计学意义(P<0.05)。PICCO组治疗48、72 h后CI、EVLWI、ITBVI、GEDVI明显高于治疗24 h后,差异有统计学意义(P<0.05)。治疗72 h后,CI、EVLWI、ITBVI、GEDVI明显高于治疗48 h后,差异有统计学意义(P<0.05)。非PICCO组治疗48 h后与治疗24 h,hs-cTnI、NT-proBNP、APACHEⅡ评分比较,差异无统计学意义(P>0.05);PICCO组治疗48 h后,hs-cTnI、NT-proBNP、APACHEⅡ评分均低于治疗24 h,且低于非PICCO组同时间点,差异有统计学意义(P<0.05)。结论PICCO监测在AMI合并CS患者治疗中具有一定的应用效果,可较好地改善组织灌注,降低AMI合并CS患者的病死率。

Objective To investigate the clinical application of pluse indicator continuous cardiac output(PICCO)monitoring in the treatment of patients with acute myocardial infarction(AMI)and cardiogenic shock(CS).Methods One hundred and seven patients with AMI and CS admitted to Xiaogan Central Hospital of Hubei Province from February 2015 to October 2018 were selected,while divided into non-PICCO group(53 cases)and PICCO group(54 cases)by random number table method.Non-PICCO group was given routine monitoring treatment,while PICCO group was treated under the guidance of PICCO.The clinical effects(including the use time of vasoactive drugs,hospitalization time,mechanical ventilation time and mortality)of the two groups were compared.The cardiac index(CI),extravascular lung water index(EVLWI),intrathoracic blood volume index(ITBVI)and global end-diastolic volume index(GEDVI)were compared in PICCO group after 24,48 and 72 hours.The changes of high sensitive troponin(hs-cTnI),N terminal pro B type natriuretic peptide(NT-proBNP)and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)scores after 24,48 hours of treatment were compared between the two groups.Results The use time of vasoactive drugs,hospitalization time and mechanical ventilation time in PICCO group were shorter than those in non-PICCO group,while the mortality rate in the PICCO group was significantly lower than that in the non-PICCO group,and the differences were statistically significant(P<0.05).After 48 and 72 hours of treatment,CI,EVLWI,ITBVI and GEDVI in PICCO group were significantly higher than those after 24 hours of treatment,and the differences were statistically significant(P<0.05).While after 72 hours of treatment,CI,EVLWI,ITBVI and GEDVI were significantly higher than those after 48 hours of treatment,and the differences were statistically significant(P<0.05).There was no significant difference in hs-cTnI,NT-proBNP and APACHEⅡscores between after 48 hours and 24 hours of treatment in non-PICCO group(P>0.05).The scores of hs-cTnI,NT-proBNP and APACHEⅡafter 48 hours of treatment in the PICCO group were lower than those after 24 hours of treatment,while were lower than those in the non-PICCO group at the same time point,and the differences were statistically significant(P<0.05).Conclusion PICCO monitoring has a certain application effect in the treatment of patients with AMI and CS.It can improve tissue perfusion and reduce the mortality of patients with AMI and CS.