血流动力学监测指导急性大面积肺栓塞早期介入治疗的价值

The value of hemodynamic monitoring in the treatment of acute massive pulmonary embolism

目的探讨血流动力学监测指导急性大面积肺栓塞(MPE)介入治疗的价值。方法 2012年1月*2015年3月ICU收治的MPE患者106例,按随机数字表法分为监测组(n=53)和对照组(n=53)。所有患者均给予静脉溶栓,监测组和对照组分别采用血流动力学监测和超声心动图评估溶栓疗效,并适时转行介入治疗。比较2组患者介入治疗疗效,溶栓后不同时间的血流动力学、血气指标及28 d病死率。结果监测组29例12 h转行介入治疗,对照组23例24 h转行介入治疗,介入治疗的总有效率分别为96.6%、82.6%(x^2=2.87,P>0.05);与0 h比较,2组溶栓后12 h、24 h MAP、CVP、RVEF均有明显升高,PASP明显降低(P<0.05),溶栓后12 h、24 h,监测组RVEF显著高于对照组,PASP显著低于对照组(P<0.05);与0 h比较,2组溶栓后24 h PO_2/FiO_2、PO_2、PCO_2均有明显改善(P<0.05),监测组溶栓后12 h PO_2/FiO_2及溶栓后24 h PO_2/FiO_2、PO_2、PCO_2均显著优于对照组(P<0.05);随访6个月,2组28 d病死率比较差异无统计学意义(P>0.05)。结论血流动力学监测评估药物溶栓效果并指导患者早期介入治疗,有助于缓解肺动脉高压,改善右心室功能。

Objective To investigate the changes of hemodynamics during interventional treatment of acute massive pulmonary embolism（MPE）.Methods From January 2012 to 2015 March,106 cases admitted to the ICU with MPE were enrolled,according to the random number table method,they were randomly divided into two groups,the monitoring group（n =53） and control group（n =53）.All patients were treated with intravenous thrombolysis,the monitoring group and the control group was used hemodynamic monitoring and ultrasound echocardiography to assess the efficacy of thrombolytic therapy,and changed to interventional therapy if needed.To compare the therapeutic effect of 2 groups,the blood flow dynamics,blood gas index and 28 d mortality rate after thrombolysis were recorded and analyzed.Results In monitoring group,29 cases after 12 h were changed to intervention therapy,in the control group,23 patients after 24 h were changed to intervention therapy,the interventional treatment＇s total efficiency were 96.6%and 82.6%respectively（x-2 = 2.87,P〈0.05）;and compared to 0 h,12 and 24 h after thrombolysis,two groups＇ MAP,CVP,RVEF were significantly increased,PASP were decreased（P〈0.05）,12 and 24 h after thrombolysis,the monitoring group＇s RVEF significantly increased,PASP decreased,which were significantly different from the control group（P〈0.05）;compared with 0 h,24 h after thrombolysis,2 group＇ PO_2/FiO_2,PO_2,PCO_2 were significantly improved（P〈0.05）,12 h after thrombolysis,the monitoring group＇s PO_2/FiO_2,and 24 h after thrombolysis,the monitoring group＇s PO_2/FiO_2 and PO_2,PCO_2 were significantly better than the control group（P〈0.05）;follow-up for six months,the two groups＇ 28 d mortality differences were not statistically significant（P〈0.05）.Conclusion Hemodynamic monitoring for drug thrombolysis and guidance for early intervention can help to relieve pulmonary hypertension,improve right ventricular function.