心内直视手术下经中心静脉置管左房测压的应用  

The application of central venous catheterization in left atrial pressure measurement under open heart surgery

作　　者：王志勇[1] WANG Zhiyong(Third People's Hospital of Anyang,Henan 4550 0 0 ,China)

机构地区：[1]安阳市第三人民医院,河南安阳455000

出　　处：《临床医药实践》2018年第2期90-92,127,共4页Proceeding of Clinical Medicine

摘　　要：目的:评价心内直视手术下经中心静脉左房测压在术后监护的准确性、安全性及可行性。方法:选择心内直视手术的18岁以上患者50例,其中男29例,女21例,年龄42~68岁。全麻诱导后经中心静脉分别置入单腔18G聚乙烯无侧孔静脉导管和8F鞘管,并由鞘管内置入肺动脉漂浮导管,体外循环结束前由卵圆孔或房间隔切一小孔,将18 G单腔管尖端放入左房,并荷包缝合。体外循环拔出左心引流后,把另一根18G单腔无侧孔聚乙烯导管经胸壁穿刺,通过右上肺静脉置入左房测压,三根导管排净空气后与同一压力转换器相连,分别记录三个导管在回到监护室后的测压值,其中肺动脉漂浮导管记录肺动脉楔压值(PAWP),并评估测压值相关性及准确性,操作难易程度,导管平均使用时间和并发症发生率。结果:经中心静脉测左房压值和经肺静脉测左房压值及经肺动脉漂浮导管测楔压值有相关性。经中心静脉测左房压值与经右上肺静脉测左房压值相关系数r=0.989;经中心静脉测左房压值与经肺动脉漂浮导管测肺动脉楔压值相关系数r=0.767;经右上肺静脉测左房压值与经肺动脉漂浮导管测得楔压值相关系数r=0.771。经中心静脉左房测压导管使用时间最长,经右上肺静脉左房测压导管使用时间最短。三种测压方法术后监护中均无导管相关并发症发生。患者无死亡。结论:心内直视手术下经中心静脉左房测压应用于手术后监护能够使用更长时间,且操作简便,无导管相关并发症;测量值与PAWP相比准确性更高。Objective:To evaluate the accuracy,safety and feasibility of open heart surgery in patients undergoing open heart surgery.Methods:All50cases of open heart surgery in patients over18years old,male29cases,female21cases,average age42~68years old,after induction of anesthesia via central vein were implanted into the single cavity18G polyethylene side hole catheter and8F sheath,and the sheath tube into the pulmonary artery catheter.Before the end of the cycle of foramen ovale or by atrial septal cut a small hole,18G single cavity tube tip into the left atrium,and suture.Pull out the left heart by-pass drainage,the other a18G single cavity without pore polyethylene catheter via chest wall puncture through the right upper pulmonary vein in left atrial manometry,three catheter drainage with the same air pressure converter connected to record three catheter in the ICU after the back pressure value respectively.The pulmonary artery catheter recorded pulmonary artery wedge pressure(PAWP),the value of pressure value and related department and evaluates the accuracy,ease of operation,the average time and complications of catheter.Results:There was a correlation between the left atrial pressure measured by central venous and the left atrial pressure measured by the pulmonary vein and the value of the pulmonary artery floating catheter.The central venous pressure value and the measurement of left atrial right superior pulmonary vein to measure the left atrial pressure value of the correlation coefficient r=0.989;the central venous pressure value and left atrial mapping through pulmonary artery catheter pulmonary artery wedge pressure correlation coefficient r=0.767;the right upper pulmonary vein to measure the left atrial pressure and pulmonary artery floating catheter measured wedge pressure value correlation coefficient r=0.771.The central venous catheter was used for the longest time.The right upper pulmonary vein left atrial catheter was used for the shortest time.No catheter related complications occurred during the postop

关 键 词：心内直视手术 中心静脉 右上肺静脉 肺动脉楔压 左房压 测压法 

分 类 号：R835.4[医药卫生—航空、航天与航海医学]