肺高压患者行右心导管检查及急性肺血管扩张试验的安全性

目的探讨肺高压患者行右心导管检查和急性肺血管扩张试验的安全性。方法前瞻性入选2007年1月至2010年9月间经右心导管检查证实为肺高压的患者,并根据临床情况进行急性肺血管扩张试验。记录操作并发症和急性肺血管扩张试验的不良反应。结果 152例患者入选,其中女性122例,男性30例,平均年龄(41.7±13.2)岁。右心导管操作的平均时间为21 min。102例患者进行了急性肺血管扩张试验。共18例(12%)患者出现了并发症或不良反应,8例(5%)并发症包括穿刺至颈动脉(1例)、局部血肿(2例)、快速性心律失常(4例)和迷走反射(1例),10例(7%)不良反应包括窦性心动过速(5例)、急性肺水肿(2例)和严重低血压(3例)。无气胸、血胸、死亡等严重并发症发生。并发症和药物不良反应能够自行好转或经治疗后好转,无后遗症。结论在肺高压患者中由有经验的医师进行右心导管检查及急性肺血管扩张试验是安全的。

Evaluation of the safety of right heart catheterization in patients with pulmonary hypertension

Objective To evaluate the safety of right heart catheterization(RHC) and acute vasodilator test in patients with pulmonary hypertension. Methods A prospective research of the patients diagnosed as pulmonary hypertension by RHC between January 2007 and September 2010 was performed.Acute vasodilator test was done if necessary.The complications of RHC and side effects of acute vasodilator test were recorded. Results There were 152 patients enrolled with a median age of(41.7±13.2) years.The median time of RHC was 21 minutes.Incidence of complications or side effects of acute vasodilator test was 12%(18/152).There were no pneumothoraxes,pulmonary hemorrhage,or deaths related to the procedure.Complications occurred in 8 patients(5%) including carotid artery mistake puncture(n=1),hematoma(n=2),arrhythmia(n=4) and vasovagal reaction(n=1) which disappeared spontaneously without hemodynamic changes.Side effects occurred in 10 patients(7%) during acute vasodilator test,which included tachycardia(n=5),severe hypotension(n=3) and acute pulmonary edema(n=2).After discontinuation of vasodilator and usage of vasoactive agent,the side effects disappeared. Conclusions When performed by experienced operators,RHC in patients with pulmonary hypertension is safe with low morbidity and mortality rates.