论文部分内容阅读
目的：探讨动脉内血压监测在急性左心衰竭并休克病人抢救治疗中对血管活性药物的指导作用。 方法：急性左心衰竭并休克的重症心脏病人１２例，左心室射血分数０．３５±０．１０，均应用了多巴胺静脉注射并静脉维持７６６．７±３１１．１μｇ／ｍｉｎ，血压仍不回升，７例病人周围血压为０，５例收缩期血压仅５０～８０ｍｍＨｇ（１ｍｍＨｇ＝０．１３３ｋＰａ），心率１１７±１５次／分。我们在常规对症治疗、强心、利尿的基础上，进行动脉内血压监测指导血管活性药物治疗。 结果：动脉内血压监测示收缩压１０４．６±１５．８ｍｍＨｇ、舒张压６６．９±１３．９ｍｍＨｇ。根据动脉内血压监测调整血管活性药物。多巴胺静脉最大维持量１０１２．５±３９３．８μｇ／ｍｉｎ，在此基础上联合硝普钠小剂量开始应用，逐渐加量至３０．６±２３．６μｇ／ｍｉｎ，半数病人同时应用多巴酚丁胺１５０～３００μｇ／ｍｉｎ以维持动脉内收缩期血压９０～１００ｍｍＨｇ。５例（５／１２）病人休克得到纠正，心力衰竭减轻，随访１个月病人稳定；２例病人病情无变化自动出院；５例（５／１２）病人经抢救治疗无效死亡。 结论：在动脉内血压监测指导下，应用大剂量多巴胺并小剂量硝普钠治?
Objective: To investigate the guiding role of arterial blood pressure monitoring on vasoactive drugs in the treatment of acute left heart failure and shock patients. Methods: Twelve patients with acute left heart failure and shock severe heart disease and left ventricular ejection fraction 0.35 ± 0.10 were treated with intravenous injection of dopamine and intravenous maintenance of 766.7 ± 311.1 μg / min, with no blood pressure The blood pressure in the 7 patients was 0,5 systolic blood pressure was only 50 ~ 80mmHg (1mmHg = 0.133kPa), the heart rate was 117 ± 15 beats / min. We routinely symptomatic treatment, cardiac, diuretic, on the basis of arterial blood pressure monitoring and guidance of vasoactive drug treatment. Results: Arterial blood pressure monitoring showed systolic blood pressure of 104.6 ± 15.8mmHg and diastolic blood pressure of 66.9 ± 13.9mmHg. Adjust vasoactive drugs based on arterial blood pressure monitoring. Dopamine intravenous maximum maintenance dose of 1012.5 ± 393.8μg / min, on this basis combined with low doses of sodium nitroprusside began to gradually increase to 30.6 ± 23.6μg / min, half of the patients at the same time with dobutamine Amine 150 ~ 300μg / min to maintain arterial systolic blood pressure 90 ~ 100mmHg. In 5 patients (5/12), shock was corrected and heart failure was alleviated. Patients were followed up for 1 month. Two patients were discharged without any change in their condition. Five patients (5/12) died after rescue treatment. Conclusion: Under the guidance of arterial blood pressure monitoring, the application of high-dose dopamine and low-dose sodium nitroprusside?