Applicaton of pulse-indicated continuous cardiac output in elderly acute myocardial infarction patients with cardiac shock
Received:February 04, 2020  
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DOI:10.11915/j.issn.1671-5403.2021.01.005
Key words:myocardial infarction  cardiogenic shock  hemodynamics  pulse-indicated continuous cardiac output This work was supported by the Youth Fund of PLA Hospital of No.305
Author NameAffiliationE-mail
LI Xiao-Gang Intensive Care Unit, Chinese PLA Hospital No.305, Bejing 100032, China majinfu305@hotmail.comapplicaton 
DING Hui-Fang Intensive Care Unit, Chinese PLA Hospital No.305, Bejing 100032, China majinfu305@hotmail.comapplicaton 
ZHANG Ning Intensive Care Unit, Chinese PLA Hospital No.305, Bejing 100032, China majinfu305@hotmail.comapplicaton 
MA Jin-Fu Intensive Care Unit, Chinese PLA Hospital No.305, Bejing 100032, China majinfu305@hotmail.comapplicaton 
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Abstract:
      Objective To explore the applicaton of pulse-indicated continuous cardiac output (PICCO) in the elderly acute myocardial infarction (AMI) patients with cardiogenic shock (CS). Methods A retrospective analysis was made of 60 AMI patients with CS, who were admitted to the intensive care unit (ICU) of our hospital from June 2013 to June 2018. The patients were divided into PICCO group (n=30) and control group (n=30). A central venous catheter was inserted into the patient of control group to measure the central venous pressure. The following items were observed and recorded before and after the treatment:lactic acid, urine volume, blood pressure, and serum B-type natriuretic peptide (BNP). Record was made of ICU admission time, mechanical ventilation time, administration time of vasoactive drug, and prognosis. The PICCO group was further divided into the survival group and the death group. The two groups were compared before and after treatment in cardiac index (CI), extravascular lung water index (EVLWI), global end-diastolic volume (GEDVI), systemic vascular resistance index (SVRI), and global ejection fraction (GEF). The above indicators were evaluated of the predictive value for the prognosis in the AMI elderly patients with CS. SPSS statistics 13.0 was used for data processing, and the receiver operating characteristic (ROC) curve was used to analyze the predictive ability of the relevant indicators for the patient′s prognosis. Results At 12,24 and 48h after the treatment, lactic acid and BNP in PICCO group were lower, and the mean hourly urine volume was higher than those in the control group, the differences being statistically significant (P<0.05 for all). The PICCO group had shorter ICU stay, mechanical ventilation and vasopressor use than the control group with statistically significant differences (P<0.05 for all). The 7-day fatality rate in the PICCO group was significantly lower than that in the control group; however, there was no statistical difference with 14-day and 28-day fatality rate. After the treatment, CI and GEF were significantly higher and EVLWI and SVRI significantly lower than those before the treatment in both survival and death groups. At 48h after the treatment, CI and GEF were significantly higher,and SVRI significantly lower in the survival group than in the death group before treatment (P<0.05 for all). ROC curve analysis suggested that CI, GEF, SVRI before the treatment and CI, GEF, SVRI, EVLWI at 48 hours after the treatment can effectively predict the 28-day prognosis. Conclusion Employment of PICCO is more effective than the traditional treatment in guiding the recovery of the elderly acute myocardial infarction patients with cardiogenic shock, and the indicators of PICCO contribute to predict prognosis.
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