急性心肌梗死后休克患者PiCCO监测指标特征与预后相关

李志波.急性心肌梗死后休克患者PiCCO监测指标特征与预后相关[J].内科急危重症杂志,2022,28(5):398-400

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DOI：10.11768/nkjwzzzz20220511

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作者	单位	E-mail
李志波	河北省沧州中西医结合医院	doctor_lzb@163.com

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中文摘要:

目的：探讨脉搏指示连续心排血量（PiCCO）监测急性心肌梗死（AMI）后休克患者血流动力学指标及其与预后之间的关联。方法：回顾性分析240例AMI后休克患者的临床资料，根据随访1个月内存活情况分为存活组（79例）和死亡组（161例）。所有患者均应用PiCCO行血流动力学监测，记录并比较2组一般资料，以及血管外肺水指数（EVLWI）、心脏指数（CI）、肺血管通透性指数（PVPI）、全心舒张末期容积指数（GEDVI）、胸腔内血容量指数（ITBVI）、全心射血分数（GEF）等PiCCO相关指标。采用单因素分析和Logistic多因素回归法分析患者随访1个月期间死亡相关因素。结果：死亡组和存活组因资料不全各排除3例和1例，最终纳入236例（存活组78例，死亡组158例）；死亡组年龄、血肌酐（Cr）、糖尿病患者比例及上机时和治疗24h后的血管外肺水指数之差（ΔEVLWI）高于存活组，ΔGEF、ΔCI、ΔPVPI低于存活组（P均＜0.05）；Cr（OR=1.027，P=0.003）和ΔEVLWI（OR=10.251，P<0.001）为患者1个月内死亡危险因素，ΔPVPI（OR=0.858，P<0.001）和ΔCI（OR=0.987，P<0.001）为其保护因素。结论：AMI后休克患者可行PiCCO监测，EVLWI、PVPI、CI变化对预后具有一定预测价值。

英文摘要:

Objective: To explore the correlations between hemodynamic parameters by pulse indicator continuous cardiac output (PiCCO) in patients with shock after acute myocardial infarction and prognosis. Methods: A retrospective analysis was performed on clinical data of 240 patients with shock after acute myocardial infarction. The patients were divided into survival group (n=79) and death group (n=161) according to survival or not within 1 month of follow-up. All patients performed hemodynamic monitoring by PiCCO, basic data and PiCCO-related indicators [extravascular lung water index (EVLWI), cardiac index (CI), pulmonary vascular permeability index (PVPI), global end diastolic volume index (GEDVI), intrathoracic blood volume index (ITBVI), global ejection fraction (GEF)] of two groups were comparatively analyzed. Univariate analysis and logistic regression were carried out on the forementioned indicators for analyzing death-related factors within 1 month of follow-up. Results: There were 3 cases and 1 case which were eliminated in death group and survival group respectively due to incomplete information. A total of 236 cases were employed finally (survival group 78 cases and death group 158 cases). Age was older, and Creatinine and the proportion of diabetes were higher in the death group than those in the survival group (all P<0.05). The general data as well as the difference between extravascular lung water index (ΔEVLWI), cardiac index (ΔCI), pulmonary vascular permeability index (ΔPVPI), global end diastolic volume index (ΔGEDVI), intrathoracic blood volume index (ΔITBVI) and global ejection fraction (ΔGEF) at the time of operation and 24h after treatment of the two groups were comparatively analyzed. ΔEVLWI in the death group was higher than that in the survival group, and ΔGEF, ΔCI and ΔPVPI in the death group were lower than those in the survival group (all P<0.05). Creatinine (OR=1.027, P=0.003) and ΔEVLWI(OR=10.251, P=0.001) were the risk factors of death within 1 month of follow-up, and ΔPVPI (OR=0.858, P=0.001) and ΔCI (OR=0.987, P=0.001) were the protective factors. Conclusion: PiCCO monitoring is feasible for patients with shock after acute myocardial infarction, and changes in EVLWI, PVPI and CI have some predictive value for prognosis.