Swan—Ganz气囊漂浮导管在重症风湿性心脏病瓣膜置换术围术期的临床应用

目的研究Swan—Ganz气囊漂浮导管在重症风湿性心脏病瓣膜置换术围术期的临床应用。方法选择20例重症风湿性心脏瓣膜病患者，年龄50～60岁，ASA马精神Ⅱ级患者6例，ASAⅢ级患者12例，ASAⅣ级患者2例；将患者依据ASA分级均等分为导管组和对照组，其中，导管组留置Swan—Ganz气囊漂浮导管时间3～5d。通过实时监测患者血流动力学变化，给予干预处理，观察患者病情变化。结果导管组患者在ICU停留的时间（20．9±15．2）h明显短于对照组在ICU停留的时间（36．2±19．4）h；导管组患者术后并发症发生情况中，低心排血量综合征及室性心律失常的发生率明显低于对照组，差异均有统计学意义（P〈0．05）。结论在重症风湿性心脏病患者在行瓣膜置换术围术期，应用漂浮导管目标导向性治疗可缩短患者在ICU的停留时间，可改善患者的预后，甚至降低并发症率和死亡率，值得临床推广使用。

CLINICAL APPLICATION OF SWAN-GANZ FLOATING CATHETER IN PERIOPERATIVE PERIOD OF VALVE REPLACEMENT OF PATIENTS WITH SEVERE RHEUMATIC HEART DISEASE

Objective To study the application of Swan - Ganz floating catheter in perioperative period of valve replacement of patients with severe rheumatic heart disease. Methods Twenty patients with severe rheumatic heart disease, age from 50 to 60, 6 of them were ASA Ⅱ, 12 of them were ASA Ⅲ and the rest two were ASA Ⅳ. Patients were divided equally into catheter group and control group according to their different ASA level. In catheter groups indwelling Swan -Ganz floating catheter for 3 - 5 d. According to hemodynamic variation of patients, give in- tervention treatment and observe the changes of patient＇s condition. Results Retention time in ICU of patients in ex-perimental group（20. 9 ± 15.2）h is significantly shorter than control group（36. 2 ± 19. 4）h; Complications, such as low cardiac output syndrome and ventricular arrhythmias, in experimental group were lower than that in control group. （p 〈 0. 05 ）. Conclusion Application of Swan - Ganz floating catheter in perioperative period of valve replacement of patients with severe rheumatic heart disease can reduce patients＇ retention time in ICU, decrease the incidence rate of complications and death.