EVLW在AMI合并急性左心功能衰竭患者诊治中的应用

发布时间：2018-05-19 13:33

本文选题：PICCO + 血管外肺水　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]探讨血管外肺水(EVLW)在急性心肌梗死合并急性左心功能衰竭患者诊治中的价值。[方法]收集昆明市延安医院心血管内科CCU病区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检测的患者病例41例,记录患者一般情况,包括年龄、性别、身高、体重、谷丙转氨酶(Alanine aminotransferase,ALT) 、谷草转氨酶(Aspartate transaminase,AST)、血尿素氮(blood urea nitrogen,BUN)、肌酐(creatinine,Cr)、总胆固醇(total cholesterol,CHOL)、甘油三酯(Triglyceride,TRIG);是否患有高血压、糖尿病;是否行PTCA或PCI治疗、治疗后患者情况,比较PiCCO法测定患者血管外肺水(EVLW)值与患者临床表现、心脏超声左室射血分数(LVEF)、胸片(Fluoroscopy of chest)肺水肿程度、脑钠肽(BNP)、血氧饱和度(Sp02)等参数的关系。对EVLW治疗前后值等计量资料采用t检验,对是否行PTCA或PCI病例数、是否合并高血压或糖尿病病例数等计数资料以频数表示;血管外肺水(EVLW)值、肝肾功能等相关实验室指标计量资料以均数±标准差(x ±s)表示;另外对血管外肺水(EVLW)与 NT-proBNP、LVEF、SpO2、cTn-I、CK-MB 五项指标相关分析,采用pearson简单线性相关分析,患者心功能Killips分级与EVLW值变化关系、EVLW值与胸片肺水肿关系采用方差分析,设定α=0.05水准,以P0. 05为差异有统计学意义。[结果]1、好转组治疗前后 EVLW 值分别为:14.65±3.38ml/kg、7.51 ± 1.86ml/kg;死亡组治疗前后EVLW值分别为:13.26±1.64ml/kg、16.05±1.32ml/kg,治疗好转组P0. 01,差异有统计学意义,说明好转组治疗后EVLW值降低;死亡组P0.05,差异有统计学意义,说明死亡组治疗后EVLW值升高。2、好转组、死亡组治疗前EVLW值分别为:14.65±3.38ml/kg、13.26±1.64ml/kg, p0.05,差异无统计学差异。说明治疗前死亡组EVLW值并不高于好转组。3、KillipsⅡ级组 EVLW 值为 9. 24 ±0. 43ml/kg、KillipsⅢ 级组 EVLW 值为 11. 98±1.00ml/kg、KillipsⅣ 级组 EVLW 值为 16. 54±1.49ml/kg。KillipsⅡ 级、Ⅲ级、Ⅳ级间进行单因素方差分析,结果显示存在差异(F=112. 35, P=0. 0000. 05);三组间进一步进行LSD两两比较:Ⅱ级与Ⅲ级P=0.210. 05无统计学差异,Ⅱ级与Ⅳ级、Ⅲ级与Ⅳ级比较均P=0.0000. 05,均有统计学差异。4、胸片表现为肺淤血(轻)间质性肺水肿(中)肺泡性肺水肿(重)时EVLW值分别为:9.54±0.80ml/kg、12.61±1.15ml/kg、17.46±1.76ml/kg。肺淤血(轻)、间质性肺水肿(中)、肺泡性肺水肿(重)间进行单因素方差分析,结果显示存在差异(F=58.186, P=0. 0000. 05),三组间进一步进行LSD两两比较:肺淤血、间质性肺水肿、肺泡性肺水肿两两比较均P=0. 0000. 05,三组间均有统计学差异。5、直线回归方程 y=54.444-1. 023x, LVEF(%)r=-0. 909,p=0.000,按照a=0.05 检验水准,P=00000. 05,差异有显著统计学意义,LVEF及EVLW值存在负相关关系。直线回归方程y=73. 79-0. 723x,SpO2(%)r=--0.929,p=0. 000,按照a=0. 05检验水准,P=0.0000.05,差异有统计学意义,SpO2及EVLW值存在负相关关系。直线回归方程y=-3. 559+0. 003x, BNPr=0. 993,P=0.000,按照a=0. 05检验水准,P=0.0000.001,差异有显著统计学意义,NT-proBNP及EVLW值存在正相关关系。直线回归方程y=14. 55-0. 005x,cTn-Ir=-0. 013,P=0.938按照a=0. 05检验水准,P=0.9380.05,差异无统计学意义,cTn-及EVLW无相关性。直线回归方程y=15.33-0. 047x,CK-MB r-0.132,P=0.946按照a=0. 05检验水准,P=0.9460.05,差异无统计学意义,CK-MB及EVLW无相关性。[结论]1. ELVW能准确反应急性心肌梗死患者的左心功能状态,是判断急性心肌梗死合并急性左心衰竭患者心功能损伤程度的重要检测手段。2. ELVW有助于指导急性心肌梗死合并急性左心衰竭患者的治疗。
[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.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.6;R542.22

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