IP应用于心梗时对肺动脉各项指标影响的评估.docVIP

IPC应用于心梗时对肺动脉各项指标影响的评估 Evaluation of Pulmonary Arterial Catheter Parameters Utilizing Intermittent Pneumatic Compression Boots in Congestive Heart Failure CHAD D. RINGLEY, M.D.,* JASON M. JOHANNING, M.D.,JAMES C. GRUENBERG, M.D.,* THOMAS J. VEVERKA, M.D.,* KIMBERLY R. BARBER, M.S. From the Departments of *Surgery and Research, Saginaw Cooperative Hospitals, Inc., Saginaw, Michigan and Department of Surgery, Section of Vascular Surgery, University of Nebraska Medical Center, Omaha, Nebraska The use of intermittent pneumatic compression boots to reduce the risk of deep venous thrombosis is contraindicated in patients with congestive heart failure (CHF) due to a theoretical increase in venous return to the heart and exacerbation of heart failure. This study evaluates intermittent pneumatic compression effects on pulmonary artery catheter parameters in CHF patients. We conducted a prospective within-patient study of CHF patients monitored by pulmonary artery catheterization. Hemodynamic variables were assessed with and without the use of intermittent pneumatic compression boots. A sample size of 18 patients was calculated a priori to obtain an 80 per cent power to detect a mean difference of 10 per cent. Twenty patients were studied; no patient suffered hemodynamic instability during the application of pneumatic compression; no statistically significant change in any hemodynamic parameters was noted. A trend toward decreasing mean arterial blood pressure (P = 0.057), pulmonary artery wedge pressure (P = 0.065), and systemic vascular resistance (P = 0.08) was observed. None were clinically significant. The application of intermittent pneumatic compression to the feet of patients in CHF does not significantly alter central hemodynamic parameters in CHF patients. This study suggests that intermittent pneumatic compression may be used in CHF patients for venous thromboembolic risk reduction. THE INCIDENCE OF deep venous thrombosis (DVT) is increased in congestive heart fa