吸入性伊洛前列素对先心病体外循环后肺动脉高压的影响

【目的】初步评估吸入性伊洛前列素对先心病伴发肺动脉高压患儿停止体外循环(CPB)后降低肺动脉高压的疗效。【方法】选择16例先心病合并肺高压的患儿,在停CPB后超声雾化吸入伊洛前列素30 ng/(kg.min),给药时间约20 min。通过持续脉冲心排量(PiCCO)导管及心内测压管测定用药前后血流动力学指标,比较吸入前、吸入结束后、吸入结束后20 min各项血流动力学参数。【结果】与吸入前比较,吸入伊洛前列素后及停药后20 min肺动脉压/体动脉压,肺循环阻力指数/体循环阻力指数,跨肺压均显著下降(P<0.01,P<0.05),心脏指数用药前后的变化无统计学差异。【结论】停CPB后吸入伊洛前列素,可选择性舒张肺血管,改善肺部血流动力学,改善右心功能。     

米力农对先天性心脏病合并肺动脉高压患者肺氧合功能及肺循环动力学的影响

目的:观察肺动脉内注射米力农对先天性心脏病合并肺动脉高压患者的肺氧合功能及肺循环动力学的影响。方法:对先天性心脏病合并肺动脉高压患者18例行右心导管术时,比较单纯高浓度吸氧患者8例与吸氧联合肺动脉内注射米力农患者10例肺动脉平均压与全肺阻力下降及动脉血氧饱和度改善情况的差异。结果:先天性心脏病合并肺动脉高压患者,吸氧联合肺动脉内注射米力农后肺动脉平均压下降[(10.22±4.78vs6.00±3.14)mmHg]与全肺阻力的降低[(3.25±1.13vs1.63±1.98)mmHg],动脉血氧饱和度的提高[(6.93±1.98)%vs(5.01±2.61)%],均优于单纯高浓度吸氧者,差异有统计学意义。结论:米力农能有效降低肺动脉平均压,改善肺氧合功能,是先天性心脏病合并肺动脉高压患者可选择的一种安全、有效的降肺动脉压药物。     

雾化吸入伊洛前列素治疗肺动脉高压的护理

目的 探讨雾化吸入伊洛前列素治疗肺动脉高压病人的护理.方法 对6例病人进行有效的心理护理;选择适合的雾化机;护理人员正确操作等.结果 6例病人临床症状明显改善,右心室内径缩小,6 min步行距离增加,吸入伊洛前列素后有轻微的不良反应,但能忍受.结论 适当有效的护理干预措施在雾化吸入伊洛前列素治疗肺动脉高压中发挥了积极有效的作用.     

静脉注射伊洛前列素治疗重度特发性肺动脉高压临床疗效

目的 观察特发性重度肺动脉高压(IPAH)患者接受静脉注射伊洛前列素治疗的临床疗效.方法 16例重度IPAH患者接受静脉注射伊洛前列素,起始量0.5 ng·kg-1·min-1持续静滴,根据病情酌情加量至1～2 ng·kg-1·min-1,治疗时间(21±5)d.观察其对心功能和非侵入性血流动力学参数的影响.结果 NYHA心功能级别改善0.8(P<0.01).非侵入性血流动力学参数明显改善:肺动脉收缩压(sPAP)从(103.7±24.1)mm Hg下降至(94.1±13.8)mm Hg(P<0.001);左心室舒张末内径(LVED)从(34.7±9.2)mm Hg增加至(37.5±9.8)mm Hg(P=0.235);右心室舒张末内径(RVED)从(46.4±8.9)mm Hg下降至(42.6±8.7)mm Hg(P=0.181).每搏输出量治疗前(36.2±16.7)ml,治疗后(37.7±18.4)ml(P=0.891).动脉血气氧分压和二氧化碳分压轻微增加.血浆B型利钠肽(BNP)浓度较治疗前明显下降[(25 008±2500)pg/ml vs.(11 327±1389)pg/ml,P<0.001].结论 静脉注射伊洛前列素能明显降低重度IPAH患者肺动脉压力,改善心功能.     

吸入伊洛前列素联合一氧化氮用于肺动脉高压术前肺血管反应试验

目的探讨雾化吸入伊洛前列素联合一氧化氮评价中重度肺动脉高压急性血管反应试验的降压效应和利用无创超声心动图监测的可行性。方法20例中重度肺动脉高压心脏病患者，先雾化吸入伊洛前列素5μg，20min后吸入一氧化氮15min。用无创技术和体表超声心动法分别测量安静状态下、雾化吸入伊洛前列素后即刻、吸入NO后即刻3个时间点的系统平均血压（MBP）、心率（HR）、肺动脉收缩压（SPAP）、肺动脉舒张压（dPAP）、平均肺动脉压（mPAP）、右心排血量（COR）、左心排血量（COL）、肺血管总阻力（PVRn）、脉搏血氧饱和度（SpO2）、左心室舒张内径（LVED）、左心室收缩内径（LVSD）、左心房内径（LAD）、射血分数（EF）。结果雾化吸入伊洛前列素和一氧化氮后MBP略有降低，但无统计学意义。雾化吸入伊洛前列素后，sPAP、dPAP、mPAP、PVR较基础值降低（均P〈0．01），吸入NO后sPAP、dPAP、mPAP、PVR有进一步降低趋势，与基础值相比有统计学意义（均P〈0．01），与吸入伊洛前列素后相比差异无统计学意义。其他测量指标的差异无统计学意义。结论雾化吸入伊洛前列素5μg和吸入一氧化氮可使有反应的肺血管扩张，用于肺血管反应性试验是安全有效的。用体表超声心动图技术监测肺血管反应性试验无创、可行且便利。     

重度肺动脉高压患儿雾化吸入伊洛前列素溶液的护理管理

目的探讨重度肺动脉高压患儿接受雾化吸入伊洛前列素溶液治疗过程中的护理管理要点,以确保患儿安全。方法采用回顾分析法,对4例重度肺动脉高压患儿雾化吸入伊洛前列素治疗过程中的护理管理要点进行总结分析。结果通过规范的护理管理和精心护理,3例患儿用药后肺动脉压力下降,无严重不良反应;1例因合并肺炎死亡。结论在伊洛前列素雾化吸入治疗的过程中,注意对患儿实施全方位的安全护理,加强管理,提高患儿治疗的信心和依从性,进一步增强治疗效果。     

先天性心脏病合并肺高压患儿术后吸入伊洛前列素治疗的护理

目的 探讨先天性心脏病合并肺高压患儿术后吸入伊洛前列素治疗在监护室的护理,以达到有双的治疗.方法 采用回顾分析法,对10例先天性心脏病患儿术后肺高压吸入伊洛前列素治疗过程中的护理进行总结分析.结果 通过规范化的护理,10例患儿肺动脉压力下降,无并发症发生,病情平稳后转回病房.结论 在吸入伊洛前列素治疗的过程中对患儿进行有效雾化吸入的护理,严密观察药物疗效和不良反应,保证了伊洛前列素的治疗效果.     

雾化吸入伊洛前列素治疗肺动脉高压的护理

目的探讨雾化吸人伊洛前列素治疗肺动脉高压病人的护理。方法对6例病人进行有效的心理护理;选择适合的雾化机;护理人员正确操作等。结果6例病人临床症状明显改善,右心室内径缩小,6min步行距离增加,吸人伊洛前列素后有轻微的不良反应,但能忍受。结论适当有效的护理干预措施在雾化吸入伊洛前列素治疗肺动脉高压中发挥了积极有效的作用。     

伊洛前列素雾化吸入给药对先天性心脏病患儿继发肺动脉高压血流动力学的影响

目的:探讨伊洛前列素雾化吸入给药对先天性心脏病患儿继发肺动脉高压的治疗作用。方法:选择一组先天性心脏病患儿用口含器或面罩吸入法吸入伊洛前列素,剂量为25～30 ng/(kg.min),以2 mL生理盐水稀释后,通过PARI Junior BOY N压机压缩雾化吸入,每4 h给药1次,吸入60、120 min后采用连续多普勒超声波技术,测量左右心每搏心排量等血流动力学参数变化。结果:在用药前和用药后60、120 min,血流动力学参数有明显变化,患儿用药后左、右心排血量增加,外周末梢血氧饱和度明显升高,用药1 h显效,于用药2 h达峰值。结论:伊洛前列素雾化吸入可以增加心输出量,改善心功能,提示应用该方法治疗先天性心脏病患儿继发肺动脉高压是有效可行的。     

伊洛前列素雾化吸入给药对先天性心脏病患儿继发肺动脉高压血流动力学的影响

目的：探讨伊洛前列素雾化吸入给药对先天性心脏病患儿继发肺动脉高压的治疗作用。方法：选择一组先天性心脏病患儿用口含器或面罩吸入法吸入伊洛前列素，剂量为25—30ng／（kg·min），以2mL生理盐水稀释后，通过PARI Junior BOYN压机压缩雾化吸入．每4h给药1次，吸入60、120min后采用连续多普勒超声波技术，测量左右心每搏心排量等血流动力学参数变化。结果：在用药前和用药后60、120min，血流动力学参数有明显变化，患儿用药后左、右心排血量增加，外周末梢血氧饱和度明显升高，用药1h显效。于用药2h达峰值。结论：伊洛前列素雾化吸入可以增加心输出量．改善心功能，提示应用该方法治疗先天性心脏病患儿继发肺动脉高压是有效可行的     

Intraoperative contrast echocardiography with intravenous optison does not cause hemodynamic changes during cardiac surgery.

BACKGROUND: The echocardiographic contrast agent Optison may be useful in patients undergoing cardiac surgery. This study investigates its effects on hemodynamics, cardiac performance, and oxygenation in this group of patients. METHODS: Parameters of hemodynamic stability, cardiac performance, and oxygenation were measured in 57 patients by transesophageal echocardiography, electrocardiography, invasive arterial blood pressure and central venous pressure monitoring, capnography, pulsoximetry, and pulmonary artery catheter before and 5 and 10 minutes after an intravenous bolus of 0.3 mL of Optison. RESULTS: No statistically significant differences in ST-segment changes, heart rate, arterial and central venous pressure, peripheral oxygen saturation, cardiac index, left ventricular ejection fraction, and regional wall motion were seen 5 and 10 minutes after injection of Optison compared with baseline parameters. CONCLUSIONS: Optison did not cause clinically important changes in parameters of hemodynamic stability, cardiac performance, and oxygenation in our patients. The intraoperative use of intravenous Optison appears to be safe in patients undergoing cardiac surgery, including in the use of cardiopulmonary bypass.     

Deciding when hemodynamic monitoring is appropriate. How will the data affect your diagnostic or therapeutic approach?

Hemodynamic data can be used to differentiate a variety of cardiopulmonary disorders, including right ventricular dysfunction, massive pulmonary embolism, and precapillary pulmonary hypertension. In patients with acute pulmonary edema, low-output states, or shock, hemodynamic measurements can help guide therapy; they also provide a precise estimate of a patient's response to vasoactive or inotropic drugs. Consider a flotation catheter for patients with complicated MIs, critically ill patients with multiorgan or major organ dysfunction, and high-risk cardiac patients undergoing surgery.     

Accuracy and precision of transcardiopulmonary thermodilution in patients with cardiogenic shock

Hemodynamic monitoring plays a crucial role in the supportive treatment of critically ill patients. In this setting, the use of the pulmonary artery catheter (PAC) is a standard procedure. In this study we prospectively compare the accuracy and precision of pulmonary thermodilution (PTD) by PAC and transcardiopulmonary thermodilution (TC-PTD) in patients with cardiogenic shock following an acute cardiac event. In this prospective study 77 hemodynamic measurements were taken in 11 patients presenting cardiogenic shock (CS) treated at the medical intensive care unit of our university hospital. Hemodynamic parameters were measured simultaneously by PTD and by TC-PTD. Both techniques assessed showed a strong correlation in the obtained hemodynamic parameters. The mean bias of cardiac index between measured by PTD (CIpa) and by TC-PTD (CIpi) was 0.04 ± 0.35 L/min/m². During intra-aortic balloon pump (IABP) counterpulsation and therapeutic hypothermia (TH) in post-resuscitation care, mean bias between CIpa and CIpi was 0.04 ± 0.36 and 0.04 ± 0.34 L/min/m², respectively. Similarly, patients presenting mitral or tricuspid regurgitation showed interchangeable parameters. Preload parameters obtained by TC-PTD showed significant differences in patients with left ventricular ejection fraction (LVEF) <35 %, compared to patients with LVEF ≥35 %. In contrast, pulmonary arterial occlusion pressure showed no significant difference. Hemodynamic measurements by PTD and TC-PTD are interchangeable during therapy of CS, including patients IABP, TH, mitral or tricuspid regurgitation. Preload parameters measured by TC-PTD seem to be more accurate in these patients than pressure parameters of PTD to gather the acute hemodynamic situation.     

主动脉内球囊反搏对血流动力学及临床预后的影响

目的:探讨主动脉内球囊反搏对血流动力学及临床预后的影响。方法:比较18例主动脉内球囊反搏治疗的患者治疗前后心率、收缩压、舒张压、平均动脉压、肺毛细血管嵌压、心脏指数、中心静脉压等血流动力学指标变化,并观察预后,比较死亡组与成活组主动脉内球囊反搏期间血流动力学差异。结果:主动脉内球囊反搏治疗后患者血流动力学改善明显(P<0.05),死亡3例(16.67%),死亡组与成活组主动脉内球囊反搏期间血流动力学差异有统计学意义(P<0.05)。结论:主动脉内球囊反搏可改善患者血流动力学指标及预后。治疗期间血流动力学监测可作为判断预后的重要指标。     

前列地尔治疗小儿重度高原性肺动脉高压的临床疗效

目的观察小儿高原性重度肺动脉高压(HPAH)患者接受静脉注射前列地尔治疗的临床疗效。方法 33例重度HPAH患者接受静脉注射前列地尔,用量5～7ng/(kg.h)持续静脉注射,治疗时间7～10d,观察其对心功能和非侵入性血流动力学参数的影响。结果纽约心脏病协会(NYHA)心功能级别改善,非侵入性血流动力学参数明显改善:肺动脉收缩压从(69.9±18.3)mm Hg下降至(35.8±13.0)mm Hg,每搏输出量治疗前(36.2±16.7)mL,治疗后(37.7±18.4)mL,动脉血气氧分压和二氧化碳分压轻微增加。血浆B型利钠肽浓度治疗前(7 799.2±6 451.6)pg/mL,治疗后(1 887.7±1 263.7)pg/mL,治疗后明显下降,差异有统计学意义(P<0.01)。结论静脉注射前列地尔治疗能明显降低重度HPAH患者肺动脉压力,改善心功能。     

老年收缩期高血压降压前后颈动脉血流动力学超声检测

目的探讨老年收缩期高血压(SHE)患者降压治疗前后超声检测颈动脉血流动力学变化并进行对比分析.方法测定109例无合并症SHE患者降压治疗前后颈动脉收缩期峰值流速(SPV)、舒张末期流速(EDV)、时间平均流速(TAV)、阻力指数(RI)和搏动指数(PI).结果降压治疗后患者RI、PI降低(P＜0.01).结论所测的血流参数对SHE患者判断疗效具有重要的临床意义.     

冠心病患者经皮腔内冠状动脉成形术后1周内心功能改变及护理对策

目的　评估冠心病患者经皮冠状动脉成形术 (percutanueoustransluminalcoronaryangioplasty,PTCA )术后 1周内心功能的改变 ,为完善PTCA围手术期护理方案提供理论依据和参考。方法　对 6 0例成功行PTCA及PTCA +支架术的冠心病患者 ,于术前 1d、术后 1～ 7d每日定时测定血流动力学参数。结果　两组患者的每搏血量 (SV)、心输出量 (CO)、心脏指数 (CI)、每搏功指数 (SWI)、心肌收缩力 (MCF)、左室总泵力 (TPF)、左室射血分数 (LVEF)及心肌耗氧量 (MVO)在术后均有一定程度的降低 ,术后第 3天最低 ,至术后第 5天或第 7天恢复至术前水平。反映心脏舒张功能的指标术后各天未见明显改变 ,均与术前无显著差异 (P >0 .0 5 )。结论　血流动力学指标的改变显示 ,PTCA术后 1周内心功能经历了从减退到逐渐恢复的过程 ,提示患者仍存在着潜在的心肌缺血的可能。PTCA术后护理应针对患者心功能的变化特征 ,加强相关时间的心功能监护     

Variable hemodynamic response to sodium nitroprusside in hypertensive crisis

Five patients, three males and two females, admitted with severe hypertensive crisis underwent hemodynamic investigations before and during vasodilator therapy with sodium nitroprusside. In three hypervolemic patients with congestive heart failure and/or renal insufficiency, the drug induced a rapid fall in systemic arterial pressure and a beneficial effect on cardiac performance, as shown by a shift of the ventricular function curves to the left. In two hypovolemic patients, the hemodynamic response was quite different; vasodilator therapy induced a confusing clinical picture characterized by significant fluctuations in blood pressure, a severe fall in cardiac output and clinical signs of shock in spite of normal blood pressure. Hemodynamic response to vasodilator therapy with sodium nitroprusside in hypertensive crisis appears to be directly related to the circulating blood volume. The syndrome of hypertension associated with hypovolemia needs to be recognized promptly in order to avoid inappropriate therapyl; in such cases volume expansion under precise hemodynamic monitoring appears to be an effective means of stabilizing the cardiocirculatory conditions.     

Clinical review: Update on hemodynamic monitoring - a consensus of 16

Hemodynamic monitoring plays a fundamental role in the management of acutely ill patients. With increased concerns about the use of invasive techniques, notably the pulmonary artery catheter, to measure cardiac output, recent years have seen an influx of new, less-invasive means of measuring hemodynamic variables, leaving the clinician somewhat bewildered as to which technique, if any, is best and which he/she should use. In this consensus paper, we try to provide some clarification, offering an objective review of the available monitoring systems, including their specific advantages and limitations, and highlighting some key principles underlying hemodynamic monitoring in critically ill patients.