华法林对创伤性肺栓塞患者血流动力学的影响

The hemodynamic effects of Warfarin on posttraumatic pulmonary embolism patients

目的探讨华法林对创伤性肺栓塞(PE)患者血流动力学的影响。方法选择2008年6至2012年9月该院收治创伤导致的PE患者40例为治疗组,同时收集同期在该院体检的健康志愿者40例作为对照组。治疗组采用华法林单纯抗凝治疗,对照组不进行治疗。监测治疗组治疗前后15、30、45h及90h的血流动力学指标以及对照组的血流动力学。结果治疗组治疗前的平均动脉压(MAP)、心脏指数(CI)、每搏输出量(SV)、每搏指数(SI)和肺动脉嵌压(PAWP)显著低于对照组,差异均有统计学意义(P<0.05)。心率(HR)、体血管阻力(SVR)、胸腔静水压(TFC)和肺循环阻(PVR)显著高于对照组,差异均有统计学意义(P<0.05)。治疗后45h时,治疗组的MAP、SV、CI、PAWP和SI显著低于对照组,差异均有统计学意义(P<0.05),90h后除PAWP差异均无统计学意义(P>0.05)。治疗组的HR、SVR和TFC在90h时仍显著高于对照组,差异有统计学意义(P<0.05),PVR和对照组相比差异无统计学意义(P>0.05)。结论监测华法林治疗创伤性PE过程中血流动力学的变化,可为此类疾病的评估和治疗提供重要的依据。

Objective To investigate the impact of Warfarin on posttraumatic pulmonary embolism patients .Methods 40 cases of posttraumatic pulmonary embolism patients from June 2008 to September 2012 in this hospital were collected as the treatment group ,40 healthy volunteers were chosen as the control group at the same time .Warfarin anticoagulant therapy was used for the treatment group ,no treatment was used in the control group .Monitoring the hemodynamic parameters of the treatment group at the time point of before treatment and 15 ,30 ,45 ,90 h after treatment .After treatment ,the hemodynamic parameters of the control group were used as control .Results Mean arterial pressure （MAP） ,cardiac index （CI） ,stroke volume （SV） ,stroke index （SI） and pulmonary artery wedge pressure （PAWP） of the treatment group were significantly lower than the control group before treatment with statistical significance （P〈0 .05） .Heart rate （HR） ,systemic vascular resistance （SVR） ,pleural hydrostatic pressure （TFC） and pulmonary vascular resistance （PVR） were significantly higher that of control group ,with statistical significance （P〈0 .05） . Before 45 h after the treatment ,MAP ,CI ,SV and SI of the treatment group were still significantly lower than the control group （P〈0 .05） ,however ,there were no statistically difference after 90 h except PAWP （P〉0 .05） .HR ,SVR and TFC of the treatment group were significantly higher than control after 90 h ,however ,the difference was not statistically significant of PVR in two groups .Conclusion Monitoring the hemodynamic changes during the treatment by Warfarin in posttraumatic pulmonary embolism patients can provide an important basis for the assessment and treatment of these diseases .