监测大面积肺栓塞后梗阻性休克患者的混合静脉血氧饱和度。

Monitoring mixed venous oxygen saturation in patients with obstructive shock after massive pulmonary embolism.

作者信息

Krivec Bojan, Voga Gorazd, Podbregar Matej

机构信息

Department for Intensive Internal Medicine, General Hospital Celje, Slovenia.

出版信息

Wien Klin Wochenschr. 2004 May 31;116(9-10):326-31. doi: 10.1007/BF03040904.

DOI:10.1007/BF03040904

PMID:15237659

Abstract

BACKGROUND

Patients with massive pulmonary embolism and obstructive shock usually require hemodynamic stabilization and thrombolysis. Little is known about the optimal and proper use of volume infusion and vasoactive drugs, or about the titration of thrombolytic agents in patients with relative contraindication for such treatment. The aim of the study was to find the most rapidly changing hemodynamic variable to monitor and optimize the treatment of patients with obstructive shock following massive pulmonary embolism.

PATIENTS AND METHODS

Ten consecutive patients hospitalized in the medical intensive care unit in the community General Hospital with obstructive shock following massive pulmonary embolism were included in the prospective observational study. Heart rate, systolic arterial pressure, central venous pressure, mean pulmonary-artery pressure, cardiac index, total pulmonary vascular-resistance index, mixed venous oxygen saturation, and urine output were measured on admission and at 1, 2, 3, 4, 8, 12, and 16 hours. Patients were treated with urokinase through the distal port of a pulmonary-artery catheter.

RESULTS

At 1 hour, mixed venous oxygen saturation, systolic arterial pressure and cardiac index were higher than their admission values (31+/-10 vs. 49+/-12%, p<0.0001; 86+/-12 vs. 105+/-17 mmHg, p<0.01; 1.5+/-0.4 vs. 1.9+/-0.7 L/min/m2, p<0.05; respectively), whereas heart rate, central venous pressure, mean pulmonary-artery pressure and urine output remained unchanged. Total pulmonary vascular-resistance index was lower than at admission (29+/-10 vs. 21+/-12 mmHg/L/min/m2, p<0.05). The relative change of mixed venous oxygen saturation at hour 1 was higher than the relative changes of all other studied variables (p<0.05). Serum lactate on admission and at 12 hours correlated to mixed venous oxygen saturation (r=-0.855, p<0.001).

CONCLUSION

In obstructive shock after massive pulmonary embolism, mixed venous oxygen saturation changes more rapidly than other standard hemodynamic variables.

摘要

背景

大面积肺栓塞和梗阻性休克患者通常需要血流动力学稳定和溶栓治疗。对于容量输注和血管活性药物的最佳和恰当使用，以及对于此类治疗有相对禁忌证的患者溶栓药物的滴定，了解甚少。本研究的目的是找出变化最迅速的血流动力学变量，以监测和优化大面积肺栓塞后梗阻性休克患者的治疗。

患者与方法

十名因大面积肺栓塞后梗阻性休克入住社区综合医院医学重症监护病房的连续患者被纳入前瞻性观察研究。入院时以及1、2、3、4、8、12和16小时测量心率、收缩动脉压、中心静脉压、平均肺动脉压、心脏指数、总肺血管阻力指数、混合静脉血氧饱和度和尿量。患者通过肺动脉导管的远端端口接受尿激酶治疗。

结果

1小时时，混合静脉血氧饱和度、收缩动脉压和心脏指数高于入院时的值（分别为31±10%对49±12%，p<0.0001；86±12对105±17 mmHg，p<0.01；1.5±0.4对1.9±0.7 L/min/m²，p<0.05），而心率、中心静脉压、平均肺动脉压和尿量保持不变。总肺血管阻力指数低于入院时（29±10对21±12 mmHg/L/min/m²，p<0.05）。1小时时混合静脉血氧饱和度的相对变化高于所有其他研究变量的相对变化（p<0.05）。入院时和12小时时的血清乳酸与混合静脉血氧饱和度相关（r=-0.855，p<0.001）。