左心房压和肺动脉楔压监测在心脏术后的应用

目的评价心脏直视术后合并肺动脉高压患者经颈内静脉安置左心房测压管和肺动脉漂浮导管对于成人心脏外科术后患者监护的可行性、安全性及准确性。方法前瞻性选择2010～2012年于武汉亚洲心脏病医院行心内直视手术的18岁以上患者100例，男43例、女57例，年龄46～65（47±16）岁。将患者分为两组：合并淤血性重度肺动脉高压患者行瓣膜置换术50例（A组），合并淤血性轻中度肺动脉高压患者行瓣膜置换术50例（B组）。两组患者均经颈内静脉入路置入ARROW5Fr三腔导管，尖端经房间隔穿刺行持续左心房压（LAP）监测；同时经同侧颈内静脉安置ARROW 8Fr高流量鞘管放置肺动脉漂浮导管，入室即监测LAP和肺动脉楔压（PAWP）。观察两组患者中LAP和PAWP的相关性及准确性。结果两组患者均成功行持续LAP及PAWP监测，无严重导管相关并发症发生。A组和B组患者手术时间和体外循环时间差异无统计学意义（P〉0．05），术后机械通气时间和ICU留置时间差异有统计学意义（P〈O．05）。A组患者平均肺动脉压（PAPMean）、平均左心房压（LAPmean）、平均肺动脉楔压（PAWPmean）、PAWP与LAP差值平均值（PAWP-LAPmean）均显著高于B组（P〈0．01）。两组患者中PAWP与LAP均具有良好相关性，A组患者相关性低于B组，差异有统计学意义（P〈0．01）。结论经颈内静脉入路行LAP监测及肺动脉漂浮导管监测是安全、可行的。PAWP不能准确反映左心室前负荷，在合并淤血性重度肺动脉高压的患者中使用LAP监测对于判断左心室前负荷更准确。

Left Atrial Pressure and Pulmonary Artery Wedge Pressure Monitoring in Patients after Cardiac Surgery

Objective To investigate the feasibility, safety and accuracy of inserting a left atrial piezometer tube and pulmonary artery flotation catheter （PAFC） via the internal jugular vein （IJV） for postoperative monitoring of adult patients with pulmonary arterial hypertension （PAH） after open cardiac surgery. Methods A prospective study was conducted in 100 patients aged over 18 years who underwent open cardiac surgery in Wuhan Asia Heart Hospital from 2010 to 2012. There were 43 male and 57 female patients with their age of 46-65 （47± 16）years. All the patients were divided into 2 groups, including 50 patients with severe PAH who underwent heart valve replacement （HVR） in group A, and 50 patients with mild to moderate PAH who underwent HVR in group B. All the patients received insertion of ARROW 5 Fr three-cavity catheter by piercing the atrial septum via IJV for continuous monitoring of left atrial pressure （LAP）, and insertion of ARROW 8Fr high-flow sheath for PAFC implantation via IJV in the same side. LAP and pulmonary artery wedge pressure （PAWP） were continuously monitored after the patients entering the intensive care unit （ICU）. The corelation and accuracy of LAP and PAWP were observed in the 2 groups. Results All the patients successfully received continuous LAP and PAWP monitoring without serious catheter-related complications. There was no statistical difference in operation time or extracorporeal circulation time between group A and B （P 〉 0.05 ）. There was statistical difference in postoperative mechanical ventilation time and length of ICU stay between the 2 groups （P 〈 0.05）. Mean pulmonary artery pressure （PAPmean）, mean LAP （LAPmean）, mean PAWP （PAWPmean）, and mean difference between PAWP and LAP （PAWP-LAPmwan ） of group A were significantly higher than those of group B （P 〈 0.01 ）. PAWP was welt correlated with LAP in both groups, and the correlation in group A was significantly milder than that in group B （P 〈 0.01 ）. Conclusi