静脉溶栓治疗对急性心肌梗死致心源性休克患者血流动力学的影响

目的：评价静脉溶栓治疗对急性心肌梗死致心源性休克患者血流动力学的影响。方法对76例急性心肌梗死致心源性休克的患者，根据溶栓的适应证和禁忌证，分为溶栓组41例和非溶栓组35例。入院12h内行脉波指示连续心排量（PiCCO）监测，获取平均动脉压（MAP）、心脏指数（CI）、胸腔内血容积指数（ITBI）、血管外肺水指数（EVLWI）、每搏指数（SVI）、全身血管阻力指数（SVRI）、全心舒张末期容积指数（GEDVI）等参数，监测中心静脉压（CVP），同时检测血浆B型利钠肽（BNP）和超敏 C反应蛋白（hs- CRP）。结果溶栓组41例患者中溶栓成功35例，不成功6例。在研究观察的7d内，溶栓组死亡2例，均在24h内死亡；非溶栓组死亡10例，其中24h内死亡6例，7d内死亡4例。溶栓组CI、SVI、MAP明显高于非溶栓组（P＜0.01）；EVLWI、ITBVI、GEDVI、CVP明显低于非溶栓组（P＜0.01）。溶栓组血浆BNP、hs- CRP、左室舒张末期内径均明显低于非溶栓组（均P＜0.01），左室射血分数较非溶栓组明显改善（P＜0.01）。结论在常规治疗的基础上溶栓治疗可进一步改善急性心肌梗死心源性休克患者血流动力学指标。PiCCO技术为心源性休克血流动力学支持提供了有效的监测手段。

Effect of intravenous thrombolytic therapy on hemodynamics in acute myocardial infarction patients with cardiac shock

Objective To investigate the effects of thrombolytic therapy on hemodynamics in acute myocardial infarction patients with cardiac shock. Methods Seventy six patients of acute myocardial infarction patients with cardiogenic shock were enrol ed in the study, including 41 patients receiving conventional treatment with intravenous thrombolytic therapy （thrombolysis group） and 35 receiving conventional treatment alone （non- thrombolysis group）. Pulse- indicated continous cardiac output （PiC-CO） was performed within 12h of admission, and the mean arterial pressure （MAP）, cardiac index （CI）, intrathoracic blood volume index（ITBI）, extravascular lung water index（EVLWI）, stroke volume index （SVI）, systemic vascular resistance index （SVRI）, global end diastolic volume index（GEDVI） and other parameters were monitored;the central venous pressure （CVP） was also monitored. Plasma B type natriuretic peptide （BNP） and high sensitive C reactive protein （hs- CRP） were measured. Results In 41 patients undergoing thrombolysis, 35 cases were successful and 6 failed. Two cases in thrombolysis group died within 24h of the study;while 10 cases died in nonthrombolysis group： 6 cases died in 24h and 4 cases died in 7d. The CI, SVI, MAP in thrombolysis group were increased and EVLWI, ITBVI, GEDVI, CVP were significantly decreased compared to non- thrombolysis group （P〈0.01）. Plasma BNP, hs- CRP and the left ventricular end diastolic diameter in thrombolysis group were significantly lower than those in non- thrombolysis group （P〈0.01）, and left ventricular ejection fraction in thrombolysis group was improved more markedly than that in non- thrombolysis group （P〈0.01）. Conclusion Thrombolytic therapy with conventional treatment can fur-ther improve hemodynamic index in acute myocardial infarction patients with cardiogenic shock.