CAJ | 학술논문

目的探讨有创血流动力学监测在急性大面积肺栓塞早期介入治疗中的指导意义.方法选取2010年6月2014年1月浙江大学衢州医院ICU收治的急性大面积肺栓塞患者40例,按随机数字表方法随机分为实验组和对照组各20例,2组患者均接受常规剂量的静脉溶栓治疗,各组溶栓疗效采取不同的评估方法.实验组采用Vigileo血流动力学监测技术,若12 h每博量变异度(SVV)、心排指数(CI)和中心静脉血氧饱和度(ScvO2)仍未达正常值者转介入(导管碎栓+接触溶栓)治疗;对照组24 h后行超声心电图检查右心室射血分数(RVEF)和肺动脉收缩压(PSAP)无改善者行介入治疗;分别比较2组患者溶栓治疗24 h后血流动力学参数、28 d生存率和6个月后RVEF、PSAP.结果溶栓治疗第12小时2组间中心静脉压(CVP)、平均动脉压(MAP)、氧合指数(PO2/FiO2)均较治疗前好转,2组间差异无统计学意义.实验组在Vigileo技术监测下,12例患者在溶栓第12小时ScvO2、SVV、CI未达正常值转入介入治疗,对照组4例患者在溶栓24 h后复查超声心动图发现RVEF、PSAP无改善转入介入治疗.2组在溶栓后第24小时CVP和MAP变化差异无统计学意义,而实验组PO2/FiO2、RVEF和PSAP改善程度明显优于对照组.实验组患者28 d生存率与对照组相当,但随访6个月后与对照组相比RVEF,PSAP明显改善.结论 Vigileo有创血流动力学监测技术可应用于评估急性大面积肺栓塞溶栓疗效并指导早期介入治疗,可尽早改善氧合和右心功能衰竭,减少继发肺动脉高压的发生和改善远期肺功能.
목적 탐토유창혈류동역학감측재급성대면적폐전새조기개입치료중적지도의의.방법 선취2010년6월2014년1월절강대학구주의원ICU수치적급성대면적폐전새환자40례,안수궤수자표방법수궤분위실험조화대조조각20례,2조환자균접수상규제량적정맥용전치료,각조용전료효채취불동적평고방법.실험조채용Vigileo혈류동역학감측기술,약12 h매박량변이도(SVV)、심배지수(CI)화중심정맥혈양포화도(ScvO2)잉미체정상치자전개입(도관쇄전+접촉용전)치료;대조조24 h후행초성심전도검사우심실사혈분수(RVEF)화폐동맥수축압(PSAP)무개선자행개입치료;분별비교2조환자용전치료24 h후혈류동역학삼수、28 d생존솔화6개월후RVEF、PSAP.결과 용전치료제12소시2조간중심정맥압(CVP)、평균동맥압(MAP)、양합지수(PO2/FiO2)균교치료전호전,2조간차이무통계학의의.실험조재Vigileo기술감측하,12례환자재용전제12소시ScvO2、SVV、CI미체정상치전입개입치료,대조조4례환자재용전24 h후복사초성심동도발현RVEF、PSAP무개선전입개입치료.2조재용전후제24소시CVP화MAP변화차이무통계학의의,이실험조PO2/FiO2、RVEF화PSAP개선정도명현우우대조조.실험조환자28 d생존솔여대조조상당,단수방6개월후여대조조상비RVEF,PSAP명현개선.결론 Vigileo유창혈류동역학감측기술가응용우평고급성대면적폐전새용전료효병지도조기개입치료,가진조개선양합화우심공능쇠갈,감소계발폐동맥고압적발생화개선원기폐공능.
Objective To investigate the clinical significance of invasive hemodynamic monitoring in early interventional treatment of acute massive pulmonary embolism.Methods From 2010 June to 2014 January,40 cases of acute massive pulmonary embolism admitted to the ICU in our hospital were analyzed divided into experimental group (20 cases) and control group (20 cases):while receiving conventional dose of peripheral venous thrombolytic therapy,the therapeutic effect of thrombolysis was evaluated by different ways.In experimental group,adopted Vigileo technology for continuous monitoring SVV,CI and ScvO2,guiding thrombolytic and interventional therapy after 12 hrs.If after 24 hrs the right ventricular ejection fraction (RVEF) and pulmonary artery systolic pressure (PSAP) did not improve,patients were converted to interventional therapy.We compared the CVP,MAP,PO2/FIO2,RVEF,PSAP,28-day mortality and the change in pulmonary vascular after 6 month.Result In two groups,CVP,MAP,PO2/FIO2 improved similarly after thrombolytic therapy.The experimental group were under the continuous monitoring of hemodynamic,12 patients were shifted to interventional therapy when ScvO2,SVV,CI did not increase after 12 hours.While 4 patients in control group were converted to interventional therapy after 24 hours.In the experimental group after 24 hours thrombolytic,the PO2/FIO2,RVEF and PSAP were higher than those in the control group.Compared with the control group,28-day mortality were same,but after follow up six moths RVEF,PSAP significantly improved.Conclusions FloTrac/Vigileo monitoring technology can be applied in assessment of massive pulmonary embolism thrombolytic to guide early interventional therapy,improve the oxygenation and right heart failure in the early stage,reduce the occurrence of pulmonary hypertension,improve the long-term pulmonary function.