漂浮导管和右心导管测量成人先天性心脏病肺循环阻力的比较性研究
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摘要
目的:比较漂浮导管和右心导管测量成人先天性心脏病肺循环阻力的一致性。方法:选择2015年10月至2017年6月,在北京安贞医院行心脏手术的先天性心脏病患者69例,其中男性30例,女性39例,年龄18～33岁,体质量45～70 kg。病种包括:房间隔缺损和室间隔缺损。手术前均行右心导管检查(RHC),确诊有中至重度肺动脉高压。患者入手术室麻醉后经右颈内静脉放置漂浮导管测量肺动脉压力,并连接Vigilance监测仪,按照菲克定律计算心排血量和肺阻力。比较由监测仪-菲克定律计算法(Fick method)和右心导管检查(RHC)所得的心排血量(CO)和肺动脉阻力(PVR)的差异性。结果:在先天性心脏病患者中Vigilance监测仪所测得的CO较实际值偏高。Fick method测得的PVR和RHC结果接近,一致性较好。结论:使用漂浮导管结合Fick method可以获得成人先天性心脏病较准确的CO和PVR等参数,与RHC结果一致性较好,可为临床医生提供治疗依据。
Objective: To study the consistency of pulmonary vascular resistance(PVR) measured by Swan-Ganz catheter and right heart catheterization(RHC) in adult congenital heart disease. Methods: From October 2015 to June 2017, 69 patients with congenital heart disease(30 males and 39 females, aged 18-33 years, weighing 45-70 kg) underwent cardiac surgery in Beijing An-zhen Hospital. The congenital heart disease included atrial septal defect and ventricular septal defect. All patients underwent RHC before surgery, and the presence of moderate to severe pulmonary hypertension was confirmed. After anesthesia, a Swan-Ganz catheter was placed to measure pulmonary artery pressure and was connected to a Vigilance II monitor to calculate cardiac output(CO) and PVR according to the Fick method. The CO and PVR measurements obtained by Vigilance II monitor-Fick method and RHC were compared. Results: CO measured by the Vigilance II monitor in the congenital heart disease patients was slightly higher than the actual value. The PVR measured by the Fick method was similar to that measured by RHC, showing good consistency. Conclusions: A Swan-Ganz catheter combined with the Fick method can be used to accurately obtain CO and PVR, showing good consistency with RHC result.
Objective: To study the consistency of pulmonary vascular resistance(PVR) measured by Swan-Ganz catheter and right heart catheterization(RHC) in adult congenital heart disease. Methods: From October 2015 to June 2017, 69 patients with congenital heart disease(30 males and 39 females, aged 18-33 years, weighing 45-70 kg) underwent cardiac surgery in Beijing An-zhen Hospital. The congenital heart disease included atrial septal defect and ventricular septal defect. All patients underwent RHC before surgery, and the presence of moderate to severe pulmonary hypertension was confirmed. After anesthesia, a Swan-Ganz catheter was placed to measure pulmonary artery pressure and was connected to a Vigilance II monitor to calculate cardiac output(CO) and PVR according to the Fick method. The CO and PVR measurements obtained by Vigilance II monitor-Fick method and RHC were compared. Results: CO measured by the Vigilance II monitor in the congenital heart disease patients was slightly higher than the actual value. The PVR measured by the Fick method was similar to that measured by RHC, showing good consistency. Conclusions: A Swan-Ganz catheter combined with the Fick method can be used to accurately obtain CO and PVR, showing good consistency with RHC result.
引文
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[2] Lowe BS, Therrien J, Ionescu-Ittu R, et al. Diagnosis of pulmonary hypertension in the congenital heart disease adult population impact on outcomes. J Am Coll Cardiol,2011,58(5):538-546.
[3] Pestana D, Garcia-de-Lorenzo A. Calculated versus measured oxygen consumption during aortic surgery: reliability of the Fick method. Anesth Analg, 1994,78(2):253-256.
[4] 刘亚光, 卿恩明, 欧阳川, 等. 120例先心患儿放置Swan-Ganz导管的体会. 临床麻醉学杂志,2008,24(3):250-258.
[5] Roberts JD, Forfia PR. Diagnosis and assessment of pulmonary vascular disease by Doppler echocardiography. Pulm Circ, 2011,1(2):160-181.
[6] Abbas AE, Fortuin FD, Schiller NB, et al. A simple method for noninvasive estimation of pulmonary vascular resistance. J Am Coll Cardiol, 2003,41(6):1021-1027.
[7] 赵万桂, 顾虹. 超声心动图评估肺动脉高压的研究进展. 心肺血管病杂志,2016,35(12):1005-1007.
[8] Galie N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J,2015,46(4):903-975.
[9] Wiener RS, Welch HG. Trends in the use of the pulmonary artery catheter in the United States, 1993-2004. JAMA,2007,298(4):423-429.
[10] Harvey S, Harrison DA, Singer M, et al. Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial. Lancet,2005,366(9484):472-477.
[11] Chatterjee K. The Swan-Ganz catheters: past, present, and future. A viewpoint. Circulation, 2009,119(1):147-152.
[2] Lowe BS, Therrien J, Ionescu-Ittu R, et al. Diagnosis of pulmonary hypertension in the congenital heart disease adult population impact on outcomes. J Am Coll Cardiol,2011,58(5):538-546.
[3] Pestana D, Garcia-de-Lorenzo A. Calculated versus measured oxygen consumption during aortic surgery: reliability of the Fick method. Anesth Analg, 1994,78(2):253-256.
[4] 刘亚光, 卿恩明, 欧阳川, 等. 120例先心患儿放置Swan-Ganz导管的体会. 临床麻醉学杂志,2008,24(3):250-258.
[5] Roberts JD, Forfia PR. Diagnosis and assessment of pulmonary vascular disease by Doppler echocardiography. Pulm Circ, 2011,1(2):160-181.
[6] Abbas AE, Fortuin FD, Schiller NB, et al. A simple method for noninvasive estimation of pulmonary vascular resistance. J Am Coll Cardiol, 2003,41(6):1021-1027.
[7] 赵万桂, 顾虹. 超声心动图评估肺动脉高压的研究进展. 心肺血管病杂志,2016,35(12):1005-1007.
[8] Galie N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J,2015,46(4):903-975.
[9] Wiener RS, Welch HG. Trends in the use of the pulmonary artery catheter in the United States, 1993-2004. JAMA,2007,298(4):423-429.
[10] Harvey S, Harrison DA, Singer M, et al. Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial. Lancet,2005,366(9484):472-477.
[11] Chatterjee K. The Swan-Ganz catheters: past, present, and future. A viewpoint. Circulation, 2009,119(1):147-152.