目的 探讨下腔静脉变异率(IVCV)与脉搏指示连续心排血量(PiCCO)监测对心肌梗死后心源性休克患者进行精细容量管理的价值.方法 以2019年2月至2022年2月石家庄市第二医院收治的90例心肌梗死后心源性休克患者为研究对象,根据干预方法分组,对照组行常规干预,观察组在下腔静脉变异率与PiCCO监测下开展精细容量管理干预.结果 72 h治疗后,观察组N-末端脑钠肽前体(NT-proBNP)、乳酸(Lac)、氧合指数(PaO2/FiO2)、24 h尿量、平均动脉压(MAP)、心指数(CI)、心功能指数(CFI)、每搏量指数(SVI)、全心射血分数(GEF)均明显优于对照组(P＜0.05),且观察组下腔静脉变异率明显高于对照组(P＜0.05).72 h治疗后,观察组急性生理与慢性健康评分(APACHE-Ⅱ)明显低于对照组,治疗总有效率明显高于对照组(97.78％比77.78％,P＜0.05).结论 在心肌梗死后心源性休克患者精细容量管理中实施下腔静脉变异率和PiCCO监测,可改善患者血流动力学与下腔静脉状况,提高临床治疗效果与患者健康管理质量,提升生存率,降低病死率.
Objective To investigate the value of monitoring inferior vena cava variation rate(IVCV)and pulse indicating continuous cardiac output(PiCCO)in fine volume management of patients with cardiogenic shock after myocardial infarction.Methods A total of ninety patients with cardiogenic shock after myocardial infarction admitted to the Second Hospital of Shijiazhuang City from February 2019 to February 2022 were included as research subjects,and they were divided into groups according to intervention methods.The control group received routine intervention,and the observation group received fine volume management intervention under the monitoring of the variation rate of inferior vena cava and PiCCO.Results After 72 h of treatment,the N-terminal brain natriuretic peptide precursor(NT-proBNP),lactate level(Lac),oxygenation index(PaO2/FiO2),24 h urine volume,mean arterial pressure(MAP),heart index(CI),heart function index(CFI),stroke volume index(SVI)and total ejection fraction(GEF)in observation group were significantly better than those in control group(P＜0.05),and the variation rate of inferior vena cava in observation group was significantly higher than that in control group(P＜0.05).After 72 h of treatment,the acute physiological and chronic health score(APACHE-Ⅱ)of the observation group was significantly lower than that of the control group,and the total effective rate was significantly higher than that of the control group(97.78％vs.77.78％,P＜0.05).Conclusion Monitoring the variation rate of inferior vena cava and PiCCO in fine volume management of patients with cardiogenic shock after myocardial infarction can improve the hemodynamics and inferior vena cava status of patients,improve the clinical treatment effect and the quality of patient health management,increase the survival rate and reduce the mortality rate.
吕云玲;卢娜;张明明;王妍;张兴;游道锋
石家庄市第二医院急诊重症医学科,河北石家庄 050000河北医科大学第一医院急诊重症医学科,河北石家庄 050000河北医科大学第一医院重症医学一科,河北石家庄 050000河北医科大学第一医院胃肠诊疗中心三科,河北石家庄 050000
临床医学
容量管理;心源性休克;心肌梗死后心源性休克;下腔静脉变异率;脉搏指示连续心输出量;血流动力学
volume management;cardiogenic shock;cardiogenic shock after myocardial infarction;variation rate of inferior vena cava;pulse indicating continuous cardiac output;hemodynamics
《中国实用内科杂志》 2024 (003)
223-227 / 5
河北省卫健委课题(No.20190416)
10.19538/j.nk2024030109
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