摘要
Background Active and effective treatment of acute myocardial infarction(AMI)with heart failure will significantly improve the patient’s prognosis and quality of life.The selection of clinical heart failure drugs is guided by the comprehensive judgment of central venous pressure,chest X-ray lung congestion degree,serum B-type natriuretic peptide(BNP)value,echocardiogram,blood pressure,etc.,which is currently the most commonly used method in clinical practice.However,the prolonged results of chest X-ray,serum BNP value and echocardiogram affect the real-time judgment of hemodynamics,which affect the accuracy of drug selection for patients with heart failure.The impedance cardiography(ICG)for hemodynamic monitoring technology can supply immediately hemodynamic results,which has been used less for the patients of AMI with heart failure at home and abroad.Therefore,this study was to evaluate the application value of ICG combined with the passive leg raise test(PLR)in AMI patients with heart failure.Methods 110 patients with AMI combined with killip grade 2 and above were randomly divided into a control group(n=55)and an ICG group(n=55).In the ICG group,heart failure treatment drugs were selected according to some parameters measured by ICG.In the control group,the treatment drugs for heart failure were selected according to routine symptoms,signs,BNP,etc.The associations of some ICG parameters of all patients with BNP,left ventricular ejection fraction(LVEF)values were analyzed.The value of BNP,LVEF value and the 6-minute walking distance(6 MWD)were determined between the two groups,on the 7th day after surgery.Results BNP value was negatively correlated with cardiac output(CO),cardiac output index(CI),stroke volume(SV),stroke output index(SI),left ventricular stroke work(LSW),left ventricular stroke work index(LSWI),left ventricular ejection time(LVET),ejection period contraction index(EPCI)(P<0.05)and positively correlated with stroke system vascular resistance(SSVR)/index(SSVRI),system volume resistance(SVR),pre-ejection period(PEP),shrink time ratio(STR)(P<0.05).Moreover,LVEF value was positively correlated with CO,CI,SV,SI,heart rate rhythm,LSW,LSWI,LVET,EPCI(P<0.05),and negatively correlated with SSVR,SSVRI,SVR,vascular elasticity,PEP,STR(P<0.05).On the 7 thpostoperative day,the BNP levels were decreased in the both two groups,and the BNP values were decreased more significantly in the ICG group compared to the control group(P<0.05).Moreover,the 6 MWD in the ICG group were significantly increased compared to the control group(P<0.05).Conclusions Some ICG parameters can reflect the early cardiac function of patients with AMI and heart failure after PCI treatment.By using ICG technology,the patient’s hemodynamics and cardiac function can be more accurately judged,and the drugs for heart failure can be further adjusted to promote the patient’s early recovery and improve the quality of life.
基金
Medical Research Project of Foshan Municipal Commission of Health and Family Planning(No.20180099)
Key Specialist Department Training Project of Foshan City,Guangdong Province of China(No.Fspy3-2015020)
Key Medical Specialist Construction Project of Foshan during the 13^th Five-Year Plan Period(No.FSZDZK135027)。
