脉搏指数连续心输出量监测在老年急性心肌梗死合并心源性休克患者治疗中的作用  

Role of PiCCO in monitoring elderly acute myocardial infarction patients with cardiac shock

作　　者：张源波[1] 韩聚强[2] 郭凯[1] 杨萌[1] 金婧茹 常华[4] 陈冬梅[1] 王玉红[1] 周荣斌[1] 和渝斌[4] ZHANG Yuan-bo HAN Ju-qiang GUO Kai et al(Emergency Department ,Affiliated Army General Hospital of Southern Medical University ,Beijing 100700,China)

机构地区：[1]南方医科大学附属陆军总医院急诊科,北京100700 [2]南方医科大学附属陆军总医院全军肝病中心,北京100700 [3]上饶市人民医院呼吸科 [4]南方医科大学附属陆军总医院心血管病研究所,北京100700

出　　处：《中华老年心脑血管病杂志》2017年第7期708-711,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：北京协和医学基金会(睿意)急诊医学研究专项基金(RE2016-004)

摘　　要：目的探讨脉搏指数连续心输出量(PiCCO)监测在老年急性心肌梗死(AMI)合并心源性休克(CS)患者中的应用价值。方法入选老年AMI合并CS入住我院急诊科患者50例。分为PiCCO组25例,非PiCCO组25例。非PiCCO组入急诊科后立即监测血压、心率、呼吸、血氧饱和度及心电图。PiCCO组在此基础上行深静脉置管+股动脉置管+PiCCO监测技术。比较2组间24h、48h血清N末端B型钠尿肽前体(NT-proBNP)、高敏肌钙蛋白I(hs-cTnI)、急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)及病死率,PiCCO组心脏指数(CI)、全心舒张末容积(GEDV)、血管外肺水指数(ELWI)的变化。结果与0h比较,治疗24h、治疗48hCI[(3.43±0.49)L/(min·m^2)、(3.74±0.51)L/(min·m^2)vs(3.06±0.65)L/(min·m^2)]显著增加,GEDV[(812.40±53.62)ml、(796.68±57.03)ml vs(860.16±63.08)ml]显著下降,ELWI[(16.28±2.95)ml/kg、(13.40±2.48)ml/kg vs(19.84±3.52)ml/kg]显著下降(P<0.001)。治疗24hPiCCO组APACHEⅡ显著低于非PiCCO组(P<0.05);治疗48hPiCCO组hs-cTnI、NT-proBNP、APACHEⅡ低于非PiCCO组(P<0.05)。28d病死率比较,PiCCO组显著低于非PiCCO组,差异有统计学意义(P<0.05)。结论 PiCCO监测技术对指导老年AMI合并CS患者的治疗有一定价值。Objective To study the role of PiCCO in monitoring elderly acute myocardial infarction （AMI） patients with cardiac shock （CS）. Methods Fifty AMI patients with CS admitted to our hospital were divided into PiCCO group （n=25） and non-PiCCO group （n=25）. Their blood pres sure,heart rate, respiration rate, blood oxygen saturation, body temperature and central venous pressure were measured. The serum levels of NT proBNP and hs-cTnI, APACHE II score and mortality at 24 and 48 h were compared bwtween the two groups. The CI,GEDV and ELWI in PiCCO group were recorded. Results The CI was significantly higher while the GEDV and ELWI were significantly lower in PiCCO group at 24 and 48 h after treatment than at 0 h （3.43±0.49 L/min· m^2 and 3. 74±0. 51 L/min· m^2 vs 3. 06±0. 65 L/min · m^2,812. 40±53. 62 ml and 796.68±57.03 ml vs 860.16±63.08 m1,16.28±2.95 ml/kg and 13. 40±2.48 ml/kg vs 19. 84± 3.52 ml/kg,P〈0. 001）. The APACHE II score was significantly lower in PiCCO group than in non PiCCO group at 24 h after treatment （P〈0.05）. The serum levels of hs-cTnI and NT-proBNP, and the APACHE II score were significantly lower in PiCCO group than in non-PiCCO group at 48 h after treatment （P〈0.05）. Conclusion PiCCO plays a certain role in monitoring elderly AMI patients with CS.

关 键 词：心肌梗死 脉搏 休克 心源性 肌钙蛋白I 中心静脉压 

分 类 号：R541.64[医药卫生—心血管疾病] R542.22[医药卫生—内科学]