Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
J Vasc Interv Radiol. 2010 Jan;21(1):81-9. doi: 10.1016/j.jvir.2009.09.026.
This study was designed to investigate the effects of repeat bolus absolute ethanol injections on cardiopulmonary hemodynamic changes during ethanol embolotherapy of inoperable congenital arteriovenous (AV) malformations in the extremities.
Thirty adult patients (14 male, 16 female; age range, 22-51 years) who underwent ethanol embolotherapy of extremity AV malformations were enrolled in the study. A pulmonary artery catheter was used to measure hemodynamic profiles at baseline (T(baseline)), immediately before (T(pre)) and after (T(post)) a bolus injection of absolute ethanol, at the time of the maximum mean pulmonary arterial pressure (PAP) value during a session (T(highest)), 10 minutes after the final injection (T(final)), and after restoration of spontaneous breathing (T(resp)).
The systolic, mean, and diastolic PAP (P < .01, P < .01, and P < .01, respectively) and the systemic vascular resistance index (P < .05) and pulmonary vascular resistance index (PVRI; P < .05) of T(highest) and T(resp) were significantly higher than values for T(final). The volume of a single bolus injection of absolute ethanol from 0.023 to 0.175 mL/kg of body weight showed that the systolic PAP (P = .02), pulmonary capillary wedge pressure (P = .02), and PVRI (P < .01) significantly increased in accordance with the increased single volume of absolute ethanol. A significant increase of the right ventricular end-diastolic volume index and right ventricular end-systolic volume index were observed at a dose of more than 0.14 mL/kg of body weight for a single bolus injection of absolute ethanol.
During ethanol embolotherapy of extremity AV malformations, significant hemodynamic changes can arise during a bolus injection of absolute ethanol. Cardiopulmonary hemodynamic profiles should be monitored closely after a bolus injection of more than 0.14 mL/kg of body weight of absolute ethanol.
本研究旨在探讨重复推注绝对乙醇对不可切除的四肢先天性动静脉（AV）畸形乙醇栓塞治疗期间心肺血流动力学变化的影响。
本研究纳入了 30 例接受四肢 AV 畸形乙醇栓塞治疗的成年患者（男 14 例，女 16 例；年龄 22-51 岁）。使用肺动脉导管在基线时（T(baseline)）、推注绝对乙醇前（T(pre)）、推注后（T(post)）、单次推注过程中达到平均肺动脉压最大值时（T(highest)）、最后一次注射后 10 分钟（T(final)）和自主呼吸恢复后（T(resp)）测量血流动力学参数。
T(highest)和 T(resp)时的收缩压、平均压和舒张压 PAP（P <.01，P <.01 和 P <.01，分别）以及全身血管阻力指数（P <.05）和肺血管阻力指数（PVRI；P <.05）均显著高于 T(final)时的值。0.023-0.175 mL/kg 体重的单次绝对乙醇推注量显示，随着单次绝对乙醇推注量的增加，收缩压 PAP（P =.02）、肺毛细血管楔压（P =.02）和 PVRI（P <.01）显著升高。单次绝对乙醇推注量大于 0.14 mL/kg 体重时，观察到右心室舒张末期容积指数和右心室收缩末期容积指数显著增加。
在四肢 AV 畸形的乙醇栓塞治疗中，单次推注绝对乙醇可引起明显的血流动力学变化。单次推注超过 0.14 mL/kg 体重的绝对乙醇后，应密切监测心肺血流动力学。
