本文選題：PICCO + 血管外肺水��； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]探討血管外肺水(EVLW)在急性心肌梗死合并急性左心功能衰竭患者診治中的價值。[方法]收集昆明市延安醫(yī)院心血管內(nèi)科CCU病區(qū)2015年5月至2017年3月收治的急性心肌梗死合并急性左心功能衰竭并接受PICCO檢測的患者病例41例,記錄患者一般情況,包括年齡、性別、身高、體重、谷丙轉(zhuǎn)氨酶(Alanine aminotransferase,ALT) 、 谷草轉(zhuǎn)氨酶(Aspartate transaminase,AST)、血尿素氮(blood urea nitrogen,BUN)、肌酐(creatinine,Cr)、總膽固醇(total cholesterol,CHOL)、甘油三酯(Triglyceride,TRIG);是否患有高血壓、糖尿病;是否行PTCA或PCI治療、治療后患者情況,比較PiCCO法測定患者血管外肺水(EVLW)值與患者臨床表現(xiàn)、心臟超聲左室射血分?jǐn)?shù)(LVEF)、胸片(Fluoroscopy of chest)肺水腫程度、腦鈉肽(BNP)、血氧飽和度(Sp02)等參數(shù)的關(guān)系。對EVLW治療前后值等計量資料采用t檢驗,對是否行PTCA或PCI病例數(shù)、是否合并高血壓或糖尿病病例數(shù)等計數(shù)資料以頻數(shù)表示;血管外肺水(EVLW)值、肝腎功能等相關(guān)實驗室指標(biāo)計量資料以均數(shù)±標(biāo)準(zhǔn)差(x ±s)表示;另外對血管外肺水(EVLW)與 NT-proBNP、LVEF、SpO2、cTn-I、CK-MB 五項指標(biāo)相關(guān)分析,采用pearson簡單線性相關(guān)分析,患者心功能Killips分級與EVLW值變化關(guān)系、EVLW值與胸片肺水腫關(guān)系采用方差分析,設(shè)定α=0.05水準(zhǔn),以P0. 05為差異有統(tǒng)計學(xué)意義。[結(jié)果]1、好轉(zhuǎn)組治療前后 EVLW 值分別為:14.65±3.38ml/kg、7.51 ± 1.86ml/kg;死亡組治療前后EVLW值分別為:13.26±1.64ml/kg、16.05±1.32ml/kg,治療好轉(zhuǎn)組P0. 01,差異有統(tǒng)計學(xué)意義,說明好轉(zhuǎn)組治療后EVLW值降低;死亡組P0.05,差異有統(tǒng)計學(xué)意義,說明死亡組治療后EVLW值升高。2、好轉(zhuǎn)組、死亡組治療前EVLW值分別為:14.65±3.38ml/kg、13.26±1.64ml/kg, p0.05,差異無統(tǒng)計學(xué)差異。說明治療前死亡組EVLW值并不高于好轉(zhuǎn)組。3、KillipsⅡ級組 EVLW 值為 9. 24 ±0. 43ml/kg、KillipsⅢ 級組 EVLW 值為 11. 98±1.00ml/kg、KillipsⅣ 級組 EVLW 值為 16. 54±1.49ml/kg。KillipsⅡ 級、Ⅲ級、Ⅳ級間進(jìn)行單因素方差分析,結(jié)果顯示存在差異(F=112. 35, P=0. 0000. 05);三組間進(jìn)一步進(jìn)行LSD兩兩比較:Ⅱ級與Ⅲ級P=0.210. 05無統(tǒng)計學(xué)差異,Ⅱ級與Ⅳ級、Ⅲ級與Ⅳ級比較均P=0.0000. 05,均有統(tǒng)計學(xué)差異。4、胸片表現(xiàn)為肺淤血(輕)間質(zhì)性肺水腫(中)肺泡性肺水腫(重)時EVLW值分別為:9.54±0.80ml/kg、12.61±1.15ml/kg、17.46±1.76ml/kg。肺淤血(輕)、間質(zhì)性肺水腫(中)、肺泡性肺水腫(重)間進(jìn)行單因素方差分析,結(jié)果顯示存在差異(F=58.186, P=0. 0000. 05),三組間進(jìn)一步進(jìn)行LSD兩兩比較:肺淤血、間質(zhì)性肺水腫、肺泡性肺水腫兩兩比較均P=0. 0000. 05,三組間均有統(tǒng)計學(xué)差異。5、直線回歸方程 y=54.444-1. 023x, LVEF(%)r=-0. 909,p=0.000,按照a=0.05 檢驗水準(zhǔn),P=00000. 05,差異有顯著統(tǒng)計學(xué)意義,LVEF及EVLW值存在負(fù)相關(guān)關(guān)系。直線回歸方程y=73. 79-0. 723x,SpO2(%)r=--0.929,p=0. 000,按照a=0. 05檢驗水準(zhǔn),P=0.0000.05,差異有統(tǒng)計學(xué)意義,SpO2及EVLW值存在負(fù)相關(guān)關(guān)系。直線回歸方程y=-3. 559+0. 003x, BNPr=0. 993,P=0.000,按照a=0. 05檢驗水準(zhǔn),P=0.0000.001,差異有顯著統(tǒng)計學(xué)意義,NT-proBNP及EVLW值存在正相關(guān)關(guān)系。直線回歸方程y=14. 55-0. 005x,cTn-Ir=-0. 013,P=0.938按照a=0. 05檢驗水準(zhǔn),P=0.9380.05,差異無統(tǒng)計學(xué)意義,cTn-及EVLW無相關(guān)性。直線回歸方程y=15.33-0. 047x,CK-MB r-0.132,P=0.946按照a=0. 05檢驗水準(zhǔn),P=0.9460.05,差異無統(tǒng)計學(xué)意義,CK-MB及EVLW無相關(guān)性。[結(jié)論]1. ELVW能準(zhǔn)確反應(yīng)急性心肌梗死患者的左心功能狀態(tài),是判斷急性心肌梗死合并急性左心衰竭患者心功能損傷程度的重要檢測手段。2. ELVW有助于指導(dǎo)急性心肌梗死合并急性左心衰竭患者的治療。
[Abstract]:[Objective] to investigate the value of extravascular pulmonary water (EVLW) in the diagnosis and treatment of acute myocardial infarction with acute left heart failure. [Methods] 41 cases of acute myocardial infarction with acute left heart failure and PICCO detection were collected from the CCU area of the Department of cardiovascular medicine, Yanan hospital, Kunming, from May 2015 to March 2017. Patient general conditions, including age, sex, height, weight, Alanine aminotransferase, ALT, Aspartate transaminase, AST, blood urea nitrogen (blood urea nitrogen, BUN), creatinine (creatinine, Cr), total cholesterol, triglycerides, glucose, sugar, and sugar Urine disease; whether PTCA or PCI treatment, after treatment of patients, compared with the PiCCO method to determine the value of extravascular pulmonary water (EVLW) in patients with the clinical manifestations, cardiac ultrasound left ventricular ejection fraction (LVEF), the degree of pulmonary edema (Fluoroscopy of chest), brain natriuretic peptide (BNP), oxygen saturation (Sp02) and other parameters. T test was used to determine whether the number of cases of PTCA or PCI, whether the number of cases of hypertension or diabetes were combined, was expressed in frequency, and the measurement data of extravascular lung water (EVLW) value, liver and kidney function and other related laboratory indexes were expressed with mean standard deviation (x + s), and the extravascular lung water (EVLW) and NT-proBNP, LVEF, SpO2, cTn-I, CK-MB five Pearson simple linear correlation analysis, Pearson simple linear correlation analysis, the relationship between the Killips classification of cardiac function and the change of EVLW value, the relationship between the EVLW value and the chest pulmonary edema by variance analysis, setting the level of alpha =0.05, with the difference of P0. 05 was statistically significant. [results]1, the EVLW value of the improvement group was 14.65 + 3.38ml/kg, 7.51 + 1.86ml, respectively. /kg, the EVLW value of the death group before and after treatment were 13.26 + 1.64ml/kg, 16.05 + 1.32ml/kg, and the treatment group P0. 01, the difference was statistically significant, indicating that the EVLW value of the improvement group decreased after treatment, and the death group P0.05, the difference was statistically significant, indicating that the EVLW value of the death group rose higher.2, the improvement group, the EVLW values before the treatment of the death group were 14.65 + 3.38ml, respectively. /kg, 13.26 + 1.64ml/kg, P0.05, the difference was not statistically significant. The EVLW value of the death group before treatment was not higher than that of the improvement group.3, the EVLW value of the Killips class II group was 9.24 + 0. 43ml/kg, the Killips III class EVLW value was 11.98 + 1.00ml/kg, and the Killips IV class group was 16.54 +. The results of variance analysis showed that there were differences (F=112. 35, P=0. 0.05), and there was no statistical difference between class II and grade III P=0.210. 05 between the three groups, class II and grade IV, grade II and grade IV, and P=0.0000. 05 in grade III and grade IV, with a statistically significant difference of.4, and the chest surface showed pulmonary oedema (middle) pulmonary oedema (middle) pulmonary edema (medium) pulmonary oedema (middle) pulmonary edema (middle). The EVLW values were 9.54 + 0.80ml/kg, 12.61 + 1.15ml/kg, 17.46 + 1.76ml/kg. pulmonary congestion (light), interstitial pulmonary edema (middle) and alveolar pulmonary edema (weight) for single factor analysis of variance. The results showed difference (F=58.186, P=0. 0.05), and the three groups were further compared with LSD 22: pulmonary congestion, interstitial pulmonary oedema, alveolar lung The edema 22 was all P=0. 0.05, and there were statistical differences between the three groups.5, the linear regression equation y=54.444-1. 023x, LVEF (%) r=-0. 909, p=0.000, and P=00000. 05 according to a=0.05 test level, and the difference between LVEF and EVLW was negative correlation. A=0. 05 test level, P=0.0000.05, the difference has statistical significance, SpO2 and EVLW values have negative correlation. Linear regression equation y=-3. 559+0. 003x, BNPr=0. 993, P=0.000, according to a=0. 05 test level, P=0.0000.001, there is significant statistical significance, NT-proBNP and the existence of positive correlation. Linear regression equation Marxism regression equation, CTn-Ir=-0. 013, P=0.938 according to a=0. 05 test level, P=0.9380.05, the difference is not statistically significant, cTn- and EVLW have no correlation. The linear regression equation y=15.33-0. 047x, CK-MB r-0.132, P=0.946 according to a=0. 05 levels, there is no statistically significant difference. [Conclusion] it can accurately reflect acute myocardial infarction. The left cardiac function of the dead patients is an important measure to determine the degree of cardiac dysfunction in patients with acute myocardial infarction and acute left heart failure.2. ELVW helps to guide the treatment of acute myocardial infarction with acute left heart failure.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.6;R542.22

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 李娟;王平;;PICCO在危重癥患者中應(yīng)用的研究進(jìn)展[J];遼寧醫(yī)學(xué)雜志;2016年06期

2 Francesco Romeo;Maria Cristina Acconcia;Domenico Sergi;Alessia Romeo;Simona Francioni;Flavia Chiarotti;Quintilio Caretta;;Percutaneous assist devices in acute myocardial infarction with cardiogenic shock: Review, meta-analysis[J];World Journal of Cardiology;2016年01期

3 施文賀;謝陽金;;老年急性心肌梗死并心源性休克22例臨床分析[J];中國現(xiàn)代藥物應(yīng)用;2015年21期

4 方顯明;林榮榮;方興;潘朝鋅;吳海珊;劉雪玲;伍業(yè)冬;;左室射血分?jǐn)?shù)對心力衰竭的診斷價值研究[J];中西醫(yī)結(jié)合心腦血管病雜志;2015年14期

5 范小龍;黃永鵬;龐榮鋒;伍增龍;廖飛娥;;PICCO在頑固性心力衰竭患者血流動力學(xué)監(jiān)測中的臨床價值[J];遼寧醫(yī)學(xué)院學(xué)報;2015年05期

6 張有強(qiáng);;X線診斷左心衰肺水腫的特征性表現(xiàn)[J];臨床醫(yī)藥文獻(xiàn)電子雜志;2015年28期

7 王立秀;謝軍;;急性心肌梗死并心源性休克的中西醫(yī)結(jié)合護(hù)理分析[J];中西醫(yī)結(jié)合心血管病電子雜志;2015年19期

8 王運;李海明;翟展藝;甘文云;趙沖;董永軍;;血管外肺水指數(shù)評估急性呼吸窘迫綜合征患者液體管理及預(yù)后的價值[J];中華實用診斷與治療雜志;2014年10期

9 徐永昊;劉曉青;何為群;徐遠(yuǎn)達(dá);陳思蓓;桑嶺;肖煥舜;麥嵐;;定標(biāo)間隔時間對感染性休克患者脈搏輪廓分析法持續(xù)心排血量監(jiān)測的影響[J];中華危重病急救醫(yī)學(xué);2014年09期

10 王曉飛;趙文俊;;基于動態(tài)光譜法的多波長脈搏血氧飽和度測量[J];光譜學(xué)與光譜分析;2014年05期

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