Ahmed Syed Shabbir, Akhtar Mohammad Irfan, Kamal Rehana
Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan.
J Ayub Med Coll Abbottabad. 2016 Oct-Dec;28(4):793-797.
Patients presenting for cardiac surgery have unstable cardiovascular disease and haemodynamics with multiple coexisting diseases. Optimal monitoring in the perioperative period is very important for best perioperative outcome. The introduction of the flow-directed pulmonary artery catheter (PAC) into clinical practice is one of the most important and popular advances in the field of cardiac anaesthesia. The objective of the study was to determine the frequency, indications and complications of pulmonary artery catheter insertion in adult open-heart surgery patients.
A Prospective observational study was conducted at cardiac operating rooms and Cardiac Intensive care unit (CICU) of Aga Khan University Hospital for a period of six months from Nov 2015 to April 2016.Two hundred and seven patients were included in this study. PAC was inserted through right/left internal jugular vein or subclavian vein. Complications noted were arrhythmias (atrial and ventricular), right bundle branch block, coiling and knotting, pulmonary artery rupture, and infection up to 72 hours of PAC insertion. Frequency and percentage were computed for gender, comorbids (Hypertension, Diabetes, Chronic kidney disease, Chronic Obstructive Pulmonary Disease) and PAC frequency of insertion, indications and complications were noted.
The frequency of PAC insertion was 47.83%. Major indications for PAC insertion were poor left ventricular function, acute coronary syndrome, cardiogenic shock, significant left main disease and valvular heart disease patients. Minor complications were found in 23.22% cases, which included arrhythmia in 19.2% cases and coiling in 4.02%.
TPulmonary artery catheter insertion is a safe technique with useful clinical application in the management of high-risk cardiac surgical patients. The PAC insertion rationale must be standardized to confirm the judicious use.
接受心脏手术的患者患有不稳定的心血管疾病，血流动力学不稳定，且存在多种并存疾病。围手术期的最佳监测对于实现最佳围手术期结局非常重要。血流导向肺动脉导管（PAC）引入临床实践是心脏麻醉领域最重要且最受欢迎的进展之一。本研究的目的是确定成年心脏直视手术患者肺动脉导管插入的频率、适应证及并发症。
于2015年11月至2016年4月在阿迦汗大学医院心脏手术室和心脏重症监护病房（CICU）进行了一项前瞻性观察研究。本研究纳入了207例患者。通过右/左颈内静脉或锁骨下静脉插入PAC。记录的并发症包括心律失常（房性和室性）、右束支传导阻滞、盘绕和打结、肺动脉破裂以及PAC插入后72小时内的感染。计算性别、合并症（高血压、糖尿病、慢性肾病、慢性阻塞性肺疾病）的频率和百分比，并记录PAC插入的频率、适应证及并发症。
PAC插入的频率为47.83%。PAC插入的主要适应证为左心室功能差、急性冠状动脉综合征、心源性休克、严重左主干病变及瓣膜性心脏病患者。23.22%的病例出现轻微并发症，其中19.2%的病例出现心律失常，4.02%的病例出现盘绕。
肺动脉导管插入是一种安全的技术，在高危心脏手术患者的管理中具有有效的临床应用。必须规范PAC插入的基本原理以确保合理使用。
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