Stewart R D, Psyhojos T, Lahey S J, Levitsky S, Campos C T
Department of Anesthesia, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
Ann Thorac Surg. 1998 Oct;66(4):1306-11. doi: 10.1016/s0003-4975(98)00760-7.
To assess the impact of central venous pressure catheter monitoring in low-risk coronary artery bypass grafting (CABG), we compared the hospital course of patients undergoing CABG with central venous pressure catheter monitoring with that of similar patients undergoing CABG with pulmonary artery catheter monitoring.
All isolated primary CABG procedures (n = 312) performed between April 22 and October 31, 1996, were evaluated, and 194 patients meeting six central venous pressure catheter use criteria were identified. Of these 194 patients, 133 (68%) underwent CABG with central venous pressure catheter monitoring, and 61 (32%) had pulmonary artery catheter monitoring owing to surgeon or anesthesiologist preference.
In-hospital mortality was similar. A trend toward increased overall complications was seen in the pulmonary artery catheter group. The total volume infused in the first 12 hours, the 24-hour weight gain, and the intubation time were significantly greater in the pulmonary artery catheter group. Increases in intensive care unit length of stay and in total hospital charges trended toward statistical significance in the pulmonary artery catheter group.
Pulmonary artery catheter use in low-risk patients undergoing CABG was associated with greater weight gain and longer intubation time and may be associated with increased morbidity and utilization of hospital resources.
为评估中心静脉压导管监测在低风险冠状动脉旁路移植术（CABG）中的影响，我们比较了接受中心静脉压导管监测的CABG患者与接受肺动脉导管监测的类似患者的住院过程。
对1996年4月22日至10月31日期间进行的所有单纯原发性CABG手术（n = 312）进行评估，确定了194例符合六项中心静脉压导管使用标准的患者。在这194例患者中，133例（68%）接受了中心静脉压导管监测的CABG，61例（32%）由于外科医生或麻醉医生的偏好接受了肺动脉导管监测。
住院死亡率相似。肺动脉导管组总体并发症有增加趋势。肺动脉导管组在最初12小时内输注的总量、24小时体重增加量和插管时间明显更长。肺动脉导管组重症监护病房住院时间和总住院费用的增加有统计学意义的趋势。
在接受CABG的低风险患者中使用肺动脉导管与体重增加更多、插管时间更长有关，并且可能与发病率增加和医院资源利用增加有关。
