Invasive hemodynamic monitoring guided early interventional treatment of acute massive pulmonary embolism / 中华普通外科杂志

ABSTRACT

Objective To investigate the clinical significance of invasive hemodynamic monitoring in early interventional treatment of acute massive pulmonary embolism.Methods From 2010 June to 2014 January,40 cases of acute massive pulmonary embolism admitted to the ICU in our hospital were analyzed divided into experimental group (20 cases) and control group (20 cases)while receiving conventional dose of peripheral venous thrombolytic therapy,the therapeutic effect of thrombolysis was evaluated by different ways.In experimental group,adopted Vigileo technology for continuous monitoring SVV,CI and ScvO2,guiding thrombolytic and interventional therapy after 12 hrs.If after 24 hrs the right ventricular ejection fraction (RVEF) and pulmonary artery systolic pressure (PSAP) did not improve,patients were converted to interventional therapy.We compared the CVP,MAP,PO2/FIO2,RVEF,PSAP,28-day mortality and the change in pulmonary vascular after 6 month.Result In two groups,CVP,MAP,PO2/FIO2 improved similarly after thrombolytic therapy.The experimental group were under the continuous monitoring of hemodynamic,12 patients were shifted to interventional therapy when ScvO2,SVV,CI did not increase after 12 hours.While 4 patients in control group were converted to interventional therapy after 24 hours.In the experimental group after 24 hours thrombolytic,the PO2/FIO2,RVEF and PSAP were higher than those in the control group.Compared with the control group,28-day mortality were same,but after follow up six moths RVEF,PSAP significantly improved.Conclusions FloTrac/Vigileo monitoring technology can be applied in assessment of massive pulmonary embolism thrombolytic to guide early interventional therapy,improve the oxygenation and right heart failure in the early stage,reduce the occurrence of pulmonary hypertension,improve the long-term pulmonary function.