中心静脉压监测在急性右室心肌梗死扩容治疗中的应用价值  

APPLICATION VALUE OF CENTRAL VENOUS PRESSURE IN THE VOLUME EXPANSION THERAPY OF ACUTE RIGHT VENTRICULAR MYOCARDIAL INFARCTION

作　　者：陈友英 陈平[1] 徐利 Chen Youying;Chen Ping;Xu Li(Department of Critical Care Medicine ,Zigong First People's Hospital,Zigong 643000,China)

机构地区：[1]四川省自贡市第一人民医院重症医学科,643000

出　　处：《中国煤炭工业医学杂志》2020年第4期379-382,共4页Chinese Journal of Coal Industry Medicine

基　　金：四川省卫生厅科研项目(编号:2018038)。

摘　　要：目的探讨中心静脉压(CVP)监测在急性右室心肌梗死扩容治疗中的应用价值。方法选取2016年1月—2019年1月我院收治的60例急性右室心肌梗死患者为观察组,用随机数字表法分为A、B、C组,每组20例,另选同时间段22例急性右室心肌梗死患者为对照组。扩容治疗中对照组患者未行CVP监测,观察组患者监测CVP,A、B、C三组患者CVP分别维持在6~12 cmH2O、13~19 cmH2O、20~26 cmH2O。比较观察组和对照组患者发病至就诊时间、发病至溶栓时间、病死率,比较四组患者治疗12 h、24 h的生命体征指标[平均动脉压(MAP)、尿量(UV)、心率(HR)、心输出量(CO)]和治疗24 h的肺水肿发生率,比较单纯右室心肌梗死与非单纯右室心肌梗死患者治疗36 h、48 h后的CVP水平。结果观察组和对照组患者发病至就诊时间、发病至溶栓时间、病死率比较,差异无统计学意义(P>0.05);A组患者治疗12h、24h的HR明显高于B、C组(P<0.05),CO、MAP、UV则明显低于B、C组(P<0.05),B组患者UV低于C组(P<0.05),C组患者治疗24h的肺水肿发生率较A、B二组高(P<0.05),A组与对照组各项指标比较,差异无统计学意义(P>0.05);单纯右室心肌梗死患者治疗36h、48h后的CVP明显高于非单纯右室心肌梗死患者(P<0.05)。结论急性右室心肌梗死扩容治疗中保持CVP在13~19cmH2O有利于纠正休克和低血压,并减少肺水肿发生,是最佳维持范围。Objective To explore the application value of central venous pressure(CVP)in the volume expansion therapy of acute right ventricular myocardial infarction.Methods Sixty patients with acute right ventricular myocardial infarction admitted to Zigong First People′s Hospital from January 2016 to September 2019 were enrolled in observation group and were divided into group A,B and C according to the computer random number table method,with 20 cases in each group.Another 22 patients with acute right ventricular myocardial infarction at the same time period were set as control group.During volume expansion therapy,control group was not given CVP monitoring,and observation group was given CVP monitoring,and group A,B and C were given CVP maintained at 6-12 cmH2O,13-19 cmH2O and 20-26 cmH2O respectively.The time from onset to treatment,the time from onset to thrombolysis and mortality rate were compared between observation group and control group,and the vital signs indexes at 12 h and 24 h of treatment[mean arterial pressure(MAP),urine volume(UV),heart rate(HR),cardiac output(CO)]and incidence rate of pulmonary edema at 24 h of treatment were compared among the four groups.The CVP level after 36 h and 48 h of treatment was compared between patients with simple right ventricular myocardial infarction and patients with non-simple right ventricular myocardial infarction.Results There were no significant differences in the time from onset to treatment,the time from onset to thrombolysis and mortality rate between observation group and control group(P>0.05).The HR in group A was significantly higher than that in group B and C at 12 h and 24 h of treatment(P<0.05)while the CO,MAP and UV were significantly lower than those in group B and C(P<0.05),and the UV in group B was lower than that in group C(P<0.05).The incidence rate of pulmonary edema in group C at 24 h of treatment was higher than that in group A and B(P<0.05),and there were no significant differences in the indicators between group A and control group(P>0.05).The

关 键 词：中心静脉压 急性右室心肌梗死 扩容治疗 肺水肿 

分 类 号：R542.22[医药卫生—心血管疾病]