急性右室梗塞的血流动力学分型的探讨

Hemodynamic classification criteria of acute right ventricular infarction

目的：探讨急性右室梗塞血流动力学分型标准，以利临床治疗。方法：依据基础右房压（ＲＡＰ）、基础肺动脉收缩压（ＰＡＳＰ）和快速扩容后ＲＡＰ升高值将２５例急性左室下壁、右室梗塞患者分为３型。Ⅰ型、Ⅱ型的区别在于右室梗塞面积的加大，但均能承受快速扩容，并且疗效好；Ⅲ型左室梗塞面积增加，且Ⅲ型不能承受快速容量负荷，需强心、扩血管的综合治疗。结果：２５例右室梗塞患者的ＰＡＳＰ与ＲＡＰ、心脏指数（ＣＩ）和肌酸磷酸激酶同功酶（ＣＫＭＢ）峰值显著相关，尤其与ＣＫＭＢ的正相关（ｒ＝０．７４），差异极显著（Ｐ＜０．００１）。

Objective:To assess the hemodynamic criteria of acute right ventricular infarction for clinical treatment.Methods:Twentyfive patients with acute left inferior wall myocardial infarction and right ventricular infarction were divided into 3 patterns according to right atrial pressure (RAP),the pulmonary artery systolic pressure (PASP) and the increment of RAP after rapid volume loading.The distinction between pattern Ⅰ and Ⅱ was the extension of right ventricular infarction and the difference between categories Ⅱand Ⅲ was enlargement of the left ventricular infarction area.Types Ⅰ and Ⅱ were improved in the clinical state by rapid volume expansion,but type Ⅲ was worse by volume loading.Results:A significant correlation of PASP peak value with peak values of RAP,cardiac index and MB creatine kinase (CKMB) was found in the 25 patients,with particularly obvious difference shown in the positive correlation between PASP and CKMB ( r =0.74, P <0.001).Conclusions:PASP is an important criterion of the hemodynamic classification.