Application Of Different Methods For Hemodynamic Monitoring Of Acute Inferior Myocardial Infarction

Background And Purpose:With the rapid development of economy and the continuous improvement of people’s living standard, the incidence of cardiovascular disease increased year by year and showed a younger trend. Acute myocardial infarction (AMI) has become a high incidence and mortality cardiovascular disease. Depending on the infarction area, the AMI can be divided into left ventricular anterior wall, inferior wall, anteroseptal wall, lateral wall and right ventricular myocardial infarction. Among them, the most special one is acute inferior myocardial infarction. The cardiac vagus nerve usually distribute in inferior-posterior wall, and acute inferior myocardial infarction can cause myocardial ischemia, hypoxia, leading to vagus nerve excitement and vasodilatation, finally result in relatively blood volume insufficient. Approximately 40～50% acute inferior myocardial infarction involving the right ventricle, results in right heart dysfunction, causing a further left anterior cardiac load and cardiac output reduction, blood pressure decline, and serious cardiac shock. Some inferior myocardial infarction exists the clinical treatment contradiction between expansion treatment and relieve of left heart load. These patients need supplement enough fluid to recovery, but also avoid the occurrence of pulmonary edema. So find balance between them is the key to effective treatment of inferior myocardial infarction. The most commonly used hemodynamic monitoring method is echocardiography, and the "gold standard" is the Swan-Ganz. Pulse indicating continuous cardiac output monitoring (PICCO) technology is the new emerging hemodynamic monitoring method, which can not only continuous monitoring the cardiac output of acute myocardial infarction patients, but also monitoring the specific parameters like the global end-diastolic volume (GEDV) and extravascular lung water index(EVLWI). By monitoring such as parameters, we can judge the patient’s cardiac function and capacity situation, which may further guide the clinical treatment of patients with acute inferior myocardial infarction.Method:A total of 32 patients with acute inferior myocardial infarction were enrolled from January 2013 to January 2014 in Chinese PLA general hospital.The 32 patients were hospitalized in CCU and underwent the PICCO, the Swan-Ganz catheter and echocardiography hemodynamic monitoring.The research was divided into two parts: the first part is comparison of the PICCO and the Swan-Ganz catheter in monitoring hemodynamic changes (The correlation analysis of hemodynamic parameters related with the changes of volume of rehydration fluids).The second part is comparison of the PICCO and echocardiography in monitoring hemodynamic changes (Monitoring the hemodynamic parameters at the time of PICCO implantation and 72 hours after implantation), through the analysis of hemodynamic data to compare the three methods in monitoring hemodynamic parameters, and to know which is superiority in acute inferior myocardial nfarction.Results:In this experiment set range of rehydration, by comparing the PICCO monitor with the Swan-Ganz catheter before and after rehydration using paired sample t test, it showed that the CO has good correlation between the two methods (before rehydration, p=0.012>0.01; after rehydration, p=0.044>0.01).The CVP have no correlation with EVLWI(r=0.143,p=0.441).GEDI have good correlation with EVLWI (r=0.769, p<0.0001). PICCO and ultrasonic parameters of CO, CI and GEF/EF have good correlation at the time of PICCO implantation (r=0.865, p=0.000; r=0.794,P=0.000; r=0.852, p=0.000) and at the time of 72h after PICCO implantation (r=0.843, p=0.001; r=0.832, P=0.001; r=0.849, p=0.000).Conclusion:In the case of same treatment goals, PICCO, Swan-Ganz catheter and echocardiography can effectively monitor the hemodynamic changes of acute inferior myocardial infarction.Three methods have their own advantages, echocardiography has less noninvasive monitoring parameters,and it can not monitoring the real-time hemodynamic changes, the Swan-Ganz is accurate, but is difficult to operate, and its trauma is larger than other methods and the indwelling time is short. the PICCO as a minimally invasive hemodynamic monitoring method can provide dynamic, continuous, accurate and perfect hemodynamic parameters, and can also show the specific parameters as GEDV and EVLWI. PICCO is convenient for clinical application and with better clinical feasibility.