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

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Abstract 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 APACHE Ⅱ scores between after 48 hours and 24 hours of treatment in non-PICCO group (P ＞ 0.05). The scores of hs-cTnI, NT-proBNP and APACHE Ⅱ after 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.

Key words： Pulse index Cardiac output Acute myocardial infarction Cardiogenic shock

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	WANG Yaqin1 YAO Huang2 HU Xiaocong1 LUAN Jin1 LI Tingyi3

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WANG Yaqin1 YAO Huang2 HU Xiaocong1 LUAN Jin1 LI Tingyi3. Clinical application of continuous cardiac output monitoring with pulse index in the treatment of acute myocardial infarction complicated with cardiogenic shock[J]. 中国医药导报, 2019, 16(29): 72-75.

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http://www.yiyaodaobao.com.cn/EN/ OR http://www.yiyaodaobao.com.cn/EN/Y2019/V16/I29/72

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