CAJ | 학술논문

目的：评价静脉溶栓治疗对急性心肌梗死致心源性休克患者血流动力学的影响。方法对76例急性心肌梗死致心源性休克的患者，根据溶栓的适应证和禁忌证，分为溶栓组41例和非溶栓组35例。入院12h内行脉波指示连续心排量（PiCCO）监测，获取平均动脉压（MAP）、心脏指数（CI）、胸腔内血容积指数（ITBI）、血管外肺水指数（EVLWI）、每搏指数（SVI）、全身血管阻力指数（SVRI）、全心舒张末期容积指数（GEDVI）等参数，监测中心静脉压（CVP），同时检测血浆B型利钠肽（BNP）和超敏 C反应蛋白（hs- CRP）。结果溶栓组41例患者中溶栓成功35例，不成功6例。在研究观察的7d内，溶栓组死亡2例，均在24h内死亡；非溶栓组死亡10例，其中24h内死亡6例，7d内死亡4例。溶栓组CI、SVI、MAP明显高于非溶栓组（P＜0.01）；EVLWI、ITBVI、GEDVI、CVP明显低于非溶栓组（P＜0.01）。溶栓组血浆BNP、hs- CRP、左室舒张末期内径均明显低于非溶栓组（均P＜0.01），左室射血分数较非溶栓组明显改善（P＜0.01）。结论在常规治疗的基础上溶栓治疗可进一步改善急性心肌梗死心源性休克患者血流动力学指标。PiCCO技术为心源性休克血流动力学支持提供了有效的监测手段。
목적：평개정맥용전치료대급성심기경사치심원성휴극환자혈류동역학적영향。방법대76례급성심기경사치심원성휴극적환자，근거용전적괄응증화금기증，분위용전조41례화비용전조35례。입원12h내행맥파지시련속심배량（PiCCO）감측，획취평균동맥압（MAP）、심장지수（CI）、흉강내혈용적지수（ITBI）、혈관외폐수지수（EVLWI）、매박지수（SVI）、전신혈관조력지수（SVRI）、전심서장말기용적지수（GEDVI）등삼수，감측중심정맥압（CVP），동시검측혈장B형리납태（BNP）화초민 C반응단백（hs- CRP）。결과용전조41례환자중용전성공35례，불성공6례。재연구관찰적7d내，용전조사망2례，균재24h내사망；비용전조사망10례，기중24h내사망6례，7d내사망4례。용전조CI、SVI、MAP명현고우비용전조（P＜0.01）；EVLWI、ITBVI、GEDVI、CVP명현저우비용전조（P＜0.01）。용전조혈장BNP、hs- CRP、좌실서장말기내경균명현저우비용전조（균P＜0.01），좌실사혈분수교비용전조명현개선（P＜0.01）。결론재상규치료적기출상용전치료가진일보개선급성심기경사심원성휴극환자혈류동역학지표。PiCCO기술위심원성휴극혈류동역학지지제공료유효적감측수단。
Objective To investigate the effects of thrombolytic therapy on hemodynamics in acute myocardial infarction patients with cardiac shock. Methods Seventy six patients of acute myocardial infarction patients with cardiogenic shock were enrol ed in the study, including 41 patients receiving conventional treatment with intravenous thrombolytic therapy (thrombolysis group) and 35 receiving conventional treatment alone (non- thrombolysis group). Pulse- indicated continous cardiac output (PiC-CO) was performed within 12h of admission, and the mean arterial pressure (MAP), cardiac index (CI), intrathoracic blood volume index(ITBI), extravascular lung water index(EVLWI), stroke volume index (SVI), systemic vascular resistance index (SVRI), global end diastolic volume index(GEDVI) and other parameters were monitored;the central venous pressure (CVP) was also monitored. Plasma B type natriuretic peptide (BNP) and high sensitive C reactive protein (hs- CRP) were measured. Results In 41 patients undergoing thrombolysis, 35 cases were successful and 6 failed. Two cases in thrombolysis group died within 24h of the study;while 10 cases died in nonthrombolysis group: 6 cases died in 24h and 4 cases died in 7d. The CI, SVI, MAP in thrombolysis group were increased and EVLWI, ITBVI, GEDVI, CVP were significantly decreased compared to non- thrombolysis group (P<0.01). Plasma BNP, hs- CRP and the left ventricular end diastolic diameter in thrombolysis group were significantly lower than those in non- thrombolysis group (P<0.01), and left ventricular ejection fraction in thrombolysis group was improved more markedly than that in non- thrombolysis group (P<0.01). Conclusion Thrombolytic therapy with conventional treatment can fur-ther improve hemodynamic index in acute myocardial infarction patients with cardiogenic shock.