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目的探讨急性右室心肌梗死扩容治疗时中心静脉压(CVP)应维持的最佳范围。方法将68例急性右室心肌梗死并低血压休克患者采用随机对照的原则分为3组(A组、B组、C组),3组均予相同的基础治疗,如休息、吸氧、镇静、止痛、抗凝、抗血小板及再灌注治疗,在此治疗的基础上给予扩容治疗,使A组患者CVP维持在6~12 cm H2O,B组患者CVP维持在13~19 cm H2O,C组患者CVP维持在20~26 cm H2O,监测患者的心率、平均动脉压、心输出量、尿量及肺水肿发生率,比较各组疗效。另分别计算出单纯右室心肌梗死与非单纯右室心肌梗死患者的CVP值并进行比较。结果B组和C组在心率、平均动脉压、心输出量、尿量方面均优于A组(P<0.05),而B组和C组比较,差异无统计学意义;A组和B组的肺水肿发生率明显低于C组(P<0.05),而A组和B组比较,差异无统计学意义;单纯右室心肌梗死组的CVP明显高于非单纯右室心肌梗死组的CVP(P<0.05)。结论急性右室心肌梗死扩容治疗时中心静脉压(CVP)应维持的最佳范围为13~19 cm H2O。
Objective To investigate the optimal range of central venous pressure (CVP) in patients with acute right ventricular myocardial infarction (DMI) during dilation. Methods 68 patients with acute right ventricular myocardial infarction and hypotension were randomly divided into three groups (group A, group B and group C). All three groups received the same basic treatment, such as rest, oxygen inhalation and sedation , Analgesia, anticoagulant, antiplatelet and reperfusion therapy. On the basis of this treatment, dilation and treatment were given to maintain the CVP in group A to 6-12 cm H2O and CV in group B to 13-19 cm H2O. In group C Patients CVP maintained at 20 ~ 26 cm H2O, monitoring of heart rate, mean arterial pressure, cardiac output, urine output and incidence of pulmonary edema, the efficacy of each group were compared. The CVP values of patients with right ventricular myocardial infarction and non-pure right ventricular myocardial infarction were calculated and compared respectively. Results In group B and group C, heart rate, mean arterial pressure, cardiac output and urine output were better than those in group A (P <0.05), but there was no significant difference between group B and group C; group A and group B Of pulmonary edema was significantly lower in group C than in group C (P <0.05), while there was no significant difference between group A and group B. The CVP in group R was significantly higher than that in group C (P <0.05). Conclusion The optimal range of CVP should be maintained at 13-19 cm H2O for the treatment of acute right ventricular myocardial infarction.