Value Discussion Of PICCO Monitor In Acute Myocardial Infarction Patients With Cardiogenic Shock

BackgroundThe mortality rate of acute myocardial infarction with cardiogenic shock is high.There often need a large amount of pressor agents and fluids to maintain the vital organperfusion pressure. At the same time, complicated with acute heart failure andpulmonary edema, there need to limit liquid input, use diuretics and so on. So make theclinical treatment more difficult. PICCO can give multiple objective indexes to guidetreatment. Between the limit of liquid input to prevent acute heart failure occurs andactive liquid strategy to improve tissue perfusion of contradictions, it have an importantreference value. It is quite advantageous for fluid management. Study at home andabroad of PICCO mainly focus on the application of septic shock. But there have notextual research whether it can improve the prognosis of cardiogenic shock caused byacute myocardial infarction. This issue mainly to study the cardiogenic shock patientsdue to acute myocardial infarction by using the PICCO monitor to guide transfusionand vasoactive drugs use, so to explore the clinical application value of PICCOmonitor.ObjectivesTo investigate the value of PICCO monitoring in patients with acute myocardialinfarction complicated with cardiogenic shock patients.MethodRetrospective cohort study, choose the department of internal medicine ICU ofFujian Provincial Hospital diagnosis and treatment of27cases of acute myocardialinfarction in patients with cardiogenic shock, depending on whether the PICCOmonitoring were divided into two groups, compare24hour infusion volume, the urinevolume and diuretic amount. And the mean arterial blood pressure, vascular active drugscore, lactate, oxygen synthetic index, cTnI and pro-BNP after24hours of treatment,the incidence of cardiogenic pulmonary edema and28day mortality. ResultCompared with the non PICCO group, PICCO group appear to be more in24hoursliquid input (P<0.05), urine volume (P<0.05), but no more difference diuretic usage(P>0.05), and cTnI and BNP were lower (P<0.05), of which cTnI decline has obviousdifference (P<0.01). There is also a significant difference in mean arterial pressure(P<0.05); After24hours’ treatment, the mean arterial pressure, lactate, oxygenationindex and vasoactive drugs were no differences between the score (P>0.05); nodifference in incidence of pulmonary edema (P>0.05), but the mortality of28d aredifferent (P<0.05), the PICCO group was lower than non PICCO group. Theparameters(CI, EVLW, GEDV, PVPI and SVRI) of PICCO group within24hoursfound no significant differences (P>0.05).ConclusionPICCO monitoring plays an active role in acute myocardial infarction patients withcardiogenic shock therapy, it can improve tissue perfusion as soon as possible, so as toimprove prognosis, decrease the mortality of acute myocardial infarction patients withcardiogenic shock.