容量性肺动脉导管在重危心血管疾病患者中的应用

The use of volume pulmonary artery chtheter for critically ill patients

目的评价用右心室射血分数（RVEF）校正的目标持续舒张末期容量指数（CEDVI）指导容量治疗.用于重危病患者的效果.方法51例重危病患者,放置容量性肺动脉导管,其间液体治疗用RVEF校正的目标CEDVI进行调控,即：RVEF 0.2,CEFVI 200～240 ml/m^2;RVEF 0.3,CEDVI 150～180 ml/m^2;RVEF 0.35,CEDVI 125～150 ml/m^2;RVEF 0.4,CEDVI 100～120 ml/m^2;RVEF 0.5,CEDVI 50～60 ml/m^2.RVEF较低时（＜30%）,早期应用正性肌力药.结果51例患者,治愈49例（96.0%）,死亡1例（2.0%）,转院治疗1例（2.0%）.结论容量性肺动脉导管指导重危病患者容量治疗能提高抢救成功率,容量负荷要结合收缩性和后负荷的动态变化调整,以平均动脉压（MAP）、尿量、乳酸值衡量组织灌注.

Objective To investigate the effects of continuous end-eiasroloc volume index（CEDVl） adjusted by right venteicular ejection fraction（RVEF） in using for volume resuscitation of critically ill patients. Methods 51 critically ill patients who Swan-Ganz volume pulmonary artery catheters were inserted in via right internal jugular or subclavian vein underwent fluid therapy. Fluid was infused according to the relationship of RVEF and CEDVI. And the relationship of RVEF and CEDVI was that when RVEF was 0.2,0.3,0.35,0.4 and 0.5 ,respecrively,CEDVI is 200 - 400ml/m^2, 150 - 180ml/m2, 125 - 150ml/m^2, 100 - 120ml/m^2, 50 - 60ml/m^2 respectively. When RVEF is 〈 0.3,positive inotropic action drug（norepinephrine or dopamine） was used. Results 49 patients were healed（the recovery rate is 96 % ）, 1 patient died（the death rate is 2 % ）, 1 patient was transferred to other hospital. Conclusion When volume resuscrarion of critically ill patients is adjusted according to the relationship of RVEF and CEDVI, and organ and organization perfusion is evaluated according to mean blood pressure（MAP）, urine output and blood lactate,the recovery rate of these patients will rise.