ObjectiveTo investigate the influence of misplaced subclavian vein (SCV) catheter into the ipsilateral internal jugular vein (IJV) on transpulmonary thermodilution (TPTD) measurements and explore the possible mechanisms preliminarily.MethodsIn this prospective study, 408 patients in whom an SCV catheterization was indicated for TPTD monitoring were enrolled. A first set of TPTD measurements was collected at baseline in all patients (group 1, SCV catheters were correctly placed; group 2, SCV catheters were misplaced into the ipsilateral IJV). The parameters included mean transit time (MTt), downslope time (DSt), cardiac index (CI), global end-diastolic volume index (GEDVI) and extra-vascular lung water index (EVLWI). A second set of TPTD measurements was performed only in those with catheter misplacement immediately after the misplaced SCV catheters being corrected (Group 3). The differences in MTt, DSt, GEDVI and EVLWI between group 2 and 3 were recorded as ΔMTt, ΔDSt, ΔGEDVI and ΔEVLWI, respectively.ResultsGEDVI and EVLWI were significantly higher (all P<0.001) in group 2 than those in group 1, while CI was not significantly different (P>0.05) between these two groups. Multivariate logistic regression identified PaO2/FiO2 [adjusted odds ratio (OR) 1.492/10 mm Hg; 95% confidence interval (CI), 1.180 - 1.884; P<0.001], GEDVI (OR=1.307/10 mL/m2, 95% CI 1.131 - 1.511; P<0.001) and EVLWI (OR=3.05; 95%CI 1.593 - 5.840; P<0.001) as the 3 independent factors associated with the misplacement of SCV catheter into the ipsilateral IJV. In group 2, GEDVI [(1041±122)mL/m2 vs. (790±102)mL/m2, P<0.001], EVLWI [(20.3±4.0)mL/kg vs. (10.3±2.3)mL/kg, P<0.001], CI [(3.6±1.2)L·min–1·m–2 vs. (2.9±1.0)L·min–1·m–2, P<0.001], MTt [(38.2±13.3)s vs. (30.8±9.4)s, P<0.001] and DSt [(18.9±7.2)s vs. (13.2±4.9)s, P<0.001)] were significantly higher than those in Group 3. Multiple regression analysis demonstrated that ΔEVLWI (R2=0.86, P<0.001) was negatively correlated with ΔMTt (coefficient±SE, –0.52±0.12; P<0.001) and positively correlated with ΔDSt (coefficient±SE, 1.45±0.17; P<0.001).ConclusionsDuring TPTD measurements, indicator injection through an SCV catheter misplaced into the ipsilateral IJV results in an overestimation of CI, GEDVI and EVLWI. The increase in DSt might be a key factor in explaining the overestimation of EVLWI in patients with misplaced SCV catheters. Given that the accurate measurements of GEDVI and EVLWI are of utmost importance for guiding resuscitation and decision-making regarding fluids administration, immediate repositioning is required if a misplacement is suspected and confirmed by the chest X-ray.
目的 探討3種不同助孕方案在≥40歲婦女體外受精-胚胎移植（IVF-ET）周期中的臨床效果。 方法 回顧性分析2010年8月－2012年2月期間，于四川大學華西第二醫院生殖中心行IVF-ET助孕、年齡≥40歲婦女共245個周期的臨床資料，排除一側卵巢缺如患者3例，余242個周期根據助孕方案不同分為3組：拮抗劑組（GnRH-A方案組）44個周期、長方案組109個周期及短方案組89個周期，比較3種方式助孕的臨床效果。 結果 3組均無早發黃體生成素峰；長方案組應用促性腺激素（Gn）的時間最長，應用Gn數量最多，獲得最高的獲卵數及獲胚數（P＜0.05）；3組的受精率、優胚率、冷凍胚胎數、周期取消率、卵巢過度刺激綜合征發生率、早期流產率均無統計學意義（P＞0.05），短方案組的種植率及臨床妊娠率最低（P＜0.05）。 結論 GnRH-a長方案在≥40歲婦女的IVF-ET周期中具有較好的臨床結局，在≥40歲婦女IVF-ET周期中具有與長方案相似的結局，并且可以減少Gn使用量，提高卵泡及胚胎質量，短方案組對≥40歲婦女臨床效果較差。