| Objective:Because of the high morbidity, disability rate and mortality of acute myocardial infarction (AMI) and ventricular insufficiency after myocardial infarction, the evaluation and protection of ventricular function after myocardial infarction have been the primary concern in clinical work. We can help making clinical plan and estimate the prognosis by exploringing the change of ventricular function after myocardial infarction.The FloTrac/Vigileo cardiac output monitor is a new kind of system for cardiac output monitoring by peripheral arterial pressure,which has the advantages of simple,minimally invasive,swift,precise and continuous monitoring. Through analysis and calculation of the peripheral arterial pressure wave, some important and useful parameters such as continuous cardiac output(CO), cardiac index(CI), stroke volume (SV), stroke volume index (SVI) and stroke volume variation(SVV) can be accurately measured, it is a major monitoring method for the patients with cardiovascular diseases and severe diseasesTo investigate the effects of percutaneous coronary intervention(PCI) on ventricular function in patients with acute ST segment elevate myocardial infarction, this study mainly focuses on the variations of ventricular function by the FloTrac/Vigileo monitor in patients with AMI before and after PCI; Meanwhile, it can give directions to the clinical therapy by analysis of the effects of myocardial infarction localization and the time point of treatment with PCI on ventricular function in patients with AMI.Methods:Totally52patients, first diagnosed as having acute myocardial infarction by Department of Cardiology,the First Affiliated Hospital of Kunming Medical College from October 2009 to February 2011,46male cases and 6 female cases, average age of 60.1±7.8, ranging from 45 to 74 years old. All of cases are collected on the basis of the diagnosis criteria of AMI from World Health Organization (WHO), these patients are divided into two groups, PCI group:39cases, average age of 59.7±7.5; Non PCI group: 13 cases, average age of 61.5±9.0. Height, weight, past medical history, electrocardiogram and echocardiography of patients were recorded after admission, meanwhile the patients were also setted intra 22G arterial sheath in the left radial artery, the FloTrac sensor links the arterial sheath with the Vigileo monitor which measures the continuons hemodynamic parameters CO,CI,SV,SVI,MAP and HR; Before and after operation 1,2,3 days,the parameters CO,CI,SV,SVI,MAP and HR were recorded respectively in PCI group,meanwhile, the results of coronary angiography,stent implantation and complications were also recorded in the group.In Non PCI group, the hemodynamic parameters CO,CI,SV,SVI,MAP and HR were recorded respectively at 0,1,2 and 3 days after admission. Both groups were treated with routine cardiovascular medicine such as ACEI,(3-receptor blocker, antiplatelet, blood lipid-lowering drugs and anticoagulant therapy, if necessary, hypotensive drugs, blood-sugar decreasing medicines,cardiac stimulants or volumic therapy would be given. The changes of CO before and after treatment by cardiac stimulants were recorded,the changes of ASV were compared before and after volumic therapy. All data were tested with SPSS 17.0 software packet, continuous data were expressed as mean±standard deviation (x±s), comparison between two groups was performed with t test,data in group were compared with paired t test. Categorical data were expressed as a percentage, the statistic data were analyzed with Chi-square test,a probability<0.05 was considered significant. without major complications. Because of the application of IABP(intra aortic balloon pump) 2 cardigenic shock cases were excluded from PCI group, but using FloTrac/Vigileo monitor,it could be found that cardiac output increased obviously after IABP.2. In this study,12cases'(killip classⅢ) cardiac function were improved by application of cedilanid.Through FloTrac/Vigileo monitor,It could be found 9 cases' CO were increased and symptom were relieved by using 0.2mg cedilanid,the other 3 cases' CO were increased and symptom were relieved by using 0.4mg cedilanid. The CO had significant change before and after treatment(p< 0.05).3. CO and SV were significantly increased in PCI group compared with those preoperative values on the 3th day postoperatively(p<0.05); In Non PCI group, CO and SV values become lower on the 3th day, but it is not statistically different(p>0.05).4. The subgroup analyses showed CO and SV values in acute anterior myocardial infarction cases were significantly higher than that in acute non-anterior myocardial infarction cases after PCI on 3th day; Comparing selective PCI group,CO values were significantly increased in the emergency PCI group(p<0.05).5. Research found that there was a good correlation between CO measured by FloTrac/Vigileo and LVEF measured by transthoracic echocardiography in acute ST-segment elevate myocardial infarction cases,correlation coefficient r is 0.61, p <0.05.Conclusions:1.The study found that FloTrac/Vigileo monitor is a simple,minimally invasive method for cardiac output. Furthermore, parameters reflecting cardiac function measured by FloTrac/Vigileo shows good correlation with LVEF measured by transthoracic echocardiography.lt could dynamically observe the cardiac functional changes around PCI in patients with STEMI.2. Research found the vascular active drugs application could be qualitatively directed, and the diagnosis and treatment of cardiovascular disease were helped by using FloTrac/Vigileo monitor.3. Through monitoring by FloTrac/Vigileo, CO of the patients with acute STEMI increased significantly after successful intracoronary stenting and complete revascularization operation of IRCA. Comparing selective PCI, the prognosis and cardiac function of the cases were significantly improved after emergency PCI.4. By using FloTrac/Vigileo monitor,and analyzing myocardial infarction localization, we can draw the conclusion that recanalization of the anterior descending coronary artery can save more live myocardial cell, prevent ventricular remodeling and improve the prognosis of the patients.
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