漂浮导管技术在监测指导急性心力衰竭患者临床治疗的价值

目的评估漂浮导管技术在监测指导急性心力衰竭（HF）患者临床治疗的价值。方法以48例经常规处理效果不佳的急诊心力衰竭患者为研究对象，尽早留置漂浮导管，留置漂浮导管后0．5h和48h，记录心率（HR）、中心静脉乐（CVP）、肺毛细血管楔压（PCWP）、心排血量（CO），并计算心脏指数（CI）、左心室每搏做功指数（LVSWI）、右心室每搏做功指数（RVSWI）、体循环阻力（SVR）、肺循环阻力（PVR），然后根据情况选用各种药物治疗。HF患者根据出院时预后分为病情好转组和病情恶化组，对两组患者留置漂浮导管后0．5h和48hHR、CVP、PCWP、CO、CI、LVSWI、RVSWI、SVR、PVR变化进行比较。结果33例病情好转患者应用监测漂浮导管治疗后与治疗前比较，心率、PCWP、CVP明显下降（均P〈0．01），SVR、PVR明显下降（P〈0．05），CO、CI、RVSWI明显升高（均P〈0．05），LVSWI明显升高（P〈0．01）；与治疗前比较，15例病情恶化患者应用监测漂浮导管治疗后HR、CVP、PCWP、CO、CI、LVSWI、RVSWI、SVR、PVR均无明显改变（均P〉0．05）。结论漂浮导管技术在血流动力学不稳定的急性心力衰竭患者的评估病情、指导临床治疗和预后评估中有再要的价值。

Role of Swan-Ganz catheter in the clinical application among patients with acute heart failure

Objective To assess the role of Swan-Ganz catheter in the clinical application of patients with acute heart failure. Methods A retrospective analysis of 48 cases of Swan-Ganz catheter was performed to identify the clinical outcomes between December 2003 and May 2009 in the First Affiliated Hospital of Wenzhou Medical College. The following observations were made out of 48 patients with the routine treatment failed on them respectively half at an hour and at 48-hour after the Swan-Ganz catheter inserted- Heart rate （HR）, central venous pressure （CVP）, pulmonary capillary wedge pressure （PCWP）, cardiac output （CO）, cardiac index （CI）, left ventricular stroke work index （LVSWI）, right ventrieular stroke work index （RVSWI）, systemic vascular resistance （SVR）, pulmonary vascular resistance （PVR）. The Patients were divided into two groups based on their respective recovery status improvement group and exacerbated group. The data of HR, CVP, PCWP, CO, CI, LVSWI, RVSWI, SVR, and PVR were obtained and compared respectively between the two groups. Results In the improvement group, its HR, CVP, PCWP, SVR, PVR were significantly reduced （P 〈 0.05） and CO, CI, LVSWI, and RVSWI were significantly higher than before （P〈 0.05）. In the exacerbated group, the use of the pulmonary artery catheter did not significantly affect HR, CVP, PCWP, CO, CI, LVSWI, RVSWI, SVR and PVR （P 〉 0.05）. Conclusion Swan-Ganz catheter plays an important role in the clinical diagnosis, evaluation and prognosis of patients with severe acute heart failure.