肺动脉飘浮导管在外科危重病人中的临床应用

Application of pulmonary artery catheter on critical surgical patients

目的评价肺动脉飘浮导管(PAC)在外科危重病人中的临床应用价值。方法重症监护病房(ICU)中26例外科危重病人,在收入ICU 6 h之内放置PAC,进行中心静脉压(CVP)、肺动脉压(PAP)、肺动脉楔压(PAWP)、心排出量(CO)等有创血流动力学动态监测以及时发现患者的病情变化。结果所有病例均置管成功,未发生严重并发症。通过对外科危重病人的有创血流动力学动态监测,及时发现张力性气胸1例、急性心包填塞1例、迟发性脾脏破裂2例、急性心源性肺水肿1例、急性呼吸窘迫综合征(ARDS)1例、重度肺动脉高压1例。及时给予相应处理。结论PAC是经典的有创血流动力学监测方法,使用安全,通过监测参数的动态观察,能及时发现外科危重病人的病情变化,及时调整治疗方案,具有较高的临床应用价值。

Objective To assess the value of pulmonary artery catheter （PAC） on critical surgical patients. Methods Twenty - six cases of critical surgical patients were given dynamically invasive hemodynamic monitoring including central venous pressure（CVP） , pulmonary arterial pressure （PAP） , puhnonary arterial wedge pressure （PAWP） , cardiac output （CO） with PAC in 6 hours after admission to our intensive care unit （ICU） . Results All the implementation of the pulmonary artery catheter were successful and with no serious complication. Using PAC, 1 case of tension hemopneumothorax, 1 case of acute cardiac tamponade, 2 cases of delayed rupture of spleen, 1 case of acute cardiogenie pulmonary edema, 1 case of acute respiratory distress syndrome were found and treated in time. Conclusion Pulmonary artery catheter is a classic, safe and effective invasive hemodynamic monitoring method and with high, clinical value for critical surgical disease.