中心静脉压监测在救治急性右室心肌梗死中的应用价值

目的探讨急性右室心肌梗死扩容治疗时中心静脉压（CVP）应维持的最佳范围。方法将68例急性右室心肌梗死并低血压休克患者采用随机对照的原则分为3组（A组、B组、C组）,3组均予相同的基础治疗,如休息、吸氧、镇静、止痛、抗凝、抗血小板及再灌注治疗,在此治疗的基础上给予扩容治疗,使A组患者CVP维持在6~12 cm H2O,B组患者CVP维持在13-19 cm H2O,C组患者CVP维持在20-26 cm H2O,监测患者的心率、平均动脉压、心输出量、尿量及肺水肿发生率,比较各组疗效。另分别计算出单纯右室心肌梗死与非单纯右室心肌梗死患者的CVP值并进行比较。结果B组和C组在心率、平均动脉压、心输出量、尿量方面均优于A组（P〈0.05）,而B组和C组比较,差异无统计学意义;A组和B组的肺水肿发生率明显低于C组（P〈0.05）,而A组和B组比较,差异无统计学意义;单纯右室心肌梗死组的CVP明显高于非单纯右室心肌梗死组的CVP（P〈0.05）。结论急性右室心肌梗死扩容治疗时中心静脉压（CVP）应维持的最佳范围为13-19 cm H2O。

Application of monitoring central venous pressure in treating acute right ventricle myocardial infarction

Objective To explore the optimum range of central venous pressure(CVP) in treating acute right ventricle myocardial infarction. Methods Sixty-eight patients with hypotension and shock due to acute right ventricle myocardial infarction were randomly divided into three groups: group A, group B and group C. All patients received the same basic treatment of rest, oxygen, sedation, analgesic, anticoagulant, anti-platelet and reperfusion therapy. On the basis, expansion treatment was used so that the CVP of patients maintained at 6-12 cm H2O in group A, 13-19 cm H2O in group B and 20-26 cm H2O in group C. Such indicators as heart rate, mean arterial pressure, cardiac output, urine output and incidence of pulmonary edema were monitored. Efficacy of each group was compared. And the CVP of pure right ventricular myocardial infarction was compared with that of non-pure right ventricular myocardial infarction. Results The heart rate, mean arterial pressure, cardiac output and urine output of group B and group C were better than group A (P<0.05), while there was no significant difference between group B and group C; The incidence of pulmonary edema of group A and group B was lower than group C (P<0.05), while there was no significant difference between group A and group B; The CVP of pure right ventricular myocardial infarction was higher than that of non-pure right ventricular myocardial infarction (P<0.05). Conclusion The optimum range of central venous pressure (CVP) in treating acute right ventricle myocardial infarction should be 13-19 cm H2O.