阻抗心动描记法在急性心肌梗死合并心源性休克患者的应用  

Application of impedance cardiography monitoring in patients with acute myocardial infarction complicating with cardiogenic shock

作　　者：魏辉[1] 李慧[2] 

机构地区：[1]湖北省天门市第一人民医院心内科,湖北天门431700 [2]湖北省天门市第一人民医院检验科,湖北天门431700

出　　处：《岭南心血管病杂志》2016年第4期424-426,436,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨阻抗心动描记法(impedance cardiography,ICG)在急性心肌梗死(acute myocardial infarction,AMI)合并心源性休克(cardiogenic shock,CS)患者中的应用价值。方法回顾性分析2015年1月至2015年10月因AMI合并CS入住湖北省天门市第一人民医院心内科重症监护病房(CCU)患者36例的临床资料,其中ICG组(21例),对照组(15例)。对照组入心脏重症监护病房后立即监测血压,心率,呼吸次数,血氧饱和度及心电图,深静脉穿刺监测中心静脉压(CVP)。ICG组在此基础上,使用Bioz.Com无创血流动力学监测仪,监测心脏指数(CI),外周血管阻力(SVR),胸部液体水平(TFC)及血清脑钠肽(BNP)浓度变化情况。结果治疗24 h、48 h、72 h记录监测数据,随着时间延长患者的外周血管阻力、胸部液体水平下降,心脏指数增加,血清脑钠肽浓度下降,差异具有统计学意义(P<0.05)。同时,胸部液体水平与血清脑钠肽浓度呈直线正相关(r=0.76,P<0.05)。ICG组患者血管活性药物使用时间、入住心脏重症监护病房时间、机械通气时间、病死率以及出院时血清N末端脑钠肽前体浓度明显低于对照组,差异有统计学意义(P均<0.05)。结论 ICG对于AMI合并CS患者的治疗具有重要价值。Objectives To investigate the application value of impedance cardiography （ICG） monitoring in patients with acute myocardial infarction （AMI） complicating with cardiogenic shock （CS）. Methods The patients were chosen because of AMI complicating with CS from January 2015 to October 2015 in The First Hospital of Tianmen City. All the patients were divided into ICG group （n=21） and control group （n=15）. Blood pressure （BP）, heart rate （HR）, respiratory rate, oxyhemoglobin saturation （SpO2）, electrocardiograph （ECG） were detected and recorded, and central venous pressure （CVP） was monitored after deep vein puncture in control group. Cardiac index （CI）, systemic vascular resistance （SVR）, thoracic fluid content （TFC） and concentration of brain natriuretic peptide （BNP） were monitored by Bioz. Com noninvasive hemodynamic monitor system in ICG group basing on the indexes of control group. The changes of CI, SVR,TFC and serum concentration of BNP were observed. Results Compared with 24 h ICG, after 48 h and 72 h, as time going, SVR,TFC decreased （P〈0.05） ; CI increased and serum concentration of BNP trended to decrease （P〈0.05）. TFC and BNP showed a positive linear correlation （r=0.76, P〈0.05）. The administration time of vasoaetive agents, duration in coronary care unit （CCU）, mechanical ventilation time and serum concentration of N- terminal pro-BNP at leaving hospital time were all significantly lower in ICG group than in control group （all P〈0.05）. Conclusion ICG monitoring is significant to the treatment in the patients with AMI complicating with CS.

关 键 词：心肌梗死 阻抗心动描记法 心源性休克 

分 类 号：R542.22[医药卫生—心血管疾病]