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中的应用

目的探讨脉搏指数连续心输出量监测(PICCO)在急性心肌梗死(AMI)合并心源性休克(CS)患者中的应用价值。方法入选2012年1月至2013年1月因AMI合并心源性休克(CS)入住南京鼓楼医院集团宿迁市人民医院心血管内科重症监护病房(CCU)患者56例。其中男性35例,女性21例,年龄28~75岁,平均(56.5±2.3)岁。随机分成PICCO组(27例)及对照组(29例)。对照组入CCU后立即监测血压,心率,呼吸次数,血氧饱和度及心电图,记录体温变化,深静脉穿刺监测中心静脉压(CVP)。PICCO组在此基础上,进行深静脉置管+股动脉置管+PICCO模块连接。监测心脏指数(CI),血管外肺水指数(EVLWI)及血清N-末端脑钠肽前体(NT-pro BNP)变化情况。结果与PICCO治疗24 h比较,治疗48 h EVLWI(8.85±0.73)ml/kg vs.(7.41±1.36)ml/kg]下降,CI(2.21±0.45)L/min·m2 vs.(2.60±0.17)L/min·m2]增加,NT-pro BNP(4069.48±65.32)pg/ml vs.(3721±20.32)pg/ml]下降,差异具有统计学意义(P0.05)。随着时间延长,EVLWI下降,CI增加,NT-pro BNP呈降低的趋势。同时,EVLWI与NT-pro BNP呈直线正相关(r=0.78,P0.05)。PICCO组患者血管活性药物使用时间,入住CCU时间,机械通气时间,病死率以及出院时血清NT-pro BNP水平明显低于对照组,差异有统计学意义(P均0.05)。结论 PICCO对于AMI合并CS患者的治疗具有重要价值。

Application of PICCO monitoring in patients with acute myocardial infarction complicating cardiogenic ;shock

Objective To investigate the application value of PICCO monitoring in patients with acute myocardial infarction （AMI） complicating cardiogenic shock （CGS）. Methods The patients （n=56, male 35, female 21, aged from 28 to 75 and average age=56.5±2.3） were chosen because of AMI complicating CGS from Jan. 2012 to Jan. 2013. All patients were randomly divided into PICCO group （n=27） and control group （n=29）. Blood pressure （BP）, heart rate （HR）, respiratory rate, oxyhemoglobin saturation （SpO2）, ECG and body temperature were detected and recorded, and CVP was monitored after deep vein puncture in control group and PICCO group immediately after entering CCU, and additionally in PICCO group, the connection of deep vein cathetering＋femoral cathetering＋PICCO module was performed and changes of CI, EVLWI and serum NT-proBNP were observed. Results Compared with 24-h PICCO, after 48-h PICCO EVLWI （8.85±0.73） mL/kg vs. （7.41±1.36） mL/kg] decreased, CI （2.21±0.45） L/min.m2 vs （2.60±0.17） L/min.m2] increased, and NT-proBNP （4069.48±65.32） pg/mL vs. （3721±20.32） pg/mL] decreased （P〈0.05）. As time going, EVLWI decreased, CI increased and NT-proBNP trended to decrease. EVLWI and NT-proBNP showed a positive linear correlation （r=0.78,P〈0.05）. The administration time of vasoactive agents, duration in CCU, mechanical ventilation time, mortality and NT-proBNP level at leaving hospital time were all significantly lower in PICCO group than those in control group （all P〈0.05）. Conclusion PICCO monitoring is significant to the treatment in the patients with AMI complicating CGS.