一項(xiàng)叫做ESCAPE的大規(guī)模臨床試驗(yàn)發(fā)現(xiàn)：死亡與使用肺動(dòng)脈導(dǎo)管并不相關(guān)、入院治療并不增加，但是提示肺動(dòng)脈導(dǎo)管不應(yīng)當(dāng)做為常規(guī)來指導(dǎo)治療。

肺動(dòng)脈導(dǎo)管是一種很薄的導(dǎo)管，插入頸靜脈穿過右側(cè)心腔進(jìn)入肺動(dòng)脈，測(cè)量來自右側(cè)心腔流和肺組織的壓力與血流。使用一個(gè)微小充氣氣囊測(cè)量來自左側(cè)心腔的壓力。有3％～5％住院治療的心衰患者使用肺動(dòng)脈導(dǎo)管。醫(yī)生還使用肺動(dòng)脈導(dǎo)管為每一個(gè)患者進(jìn)行個(gè)體化藥物治療，測(cè)量藥物對(duì)心臟功能和癥狀的作用。

ESCAPE試驗(yàn)包括26個(gè)地區(qū)的433例患者。初始目標(biāo)是評(píng)估肺動(dòng)脈導(dǎo)管測(cè)量心臟和肺壓力精確度的提高，與其它基于對(duì)生理體征與癥狀臨床評(píng)估的治療方法相比較，是否能夠提高患者生存率以及在6個(gè)月內(nèi)減少住院時(shí)間。

Brigham and Women醫(yī)院的首席研究員Lynne Stevenson博士質(zhì)問說：“我們知道接受肺動(dòng)脈導(dǎo)管的患者感覺好了許多，但是為什么他們的死亡與住院治療并不減少？” Stevenson醫(yī)生相信，隱藏于事實(shí)后面的答案是：用于治療患者的肺動(dòng)脈導(dǎo)管的資料存在巨大差異。研究人員正在對(duì)臨床試驗(yàn)中的超聲心動(dòng)圖資料進(jìn)行深度分析，這或許能夠提供調(diào)整治療方法的手段，而無需冒肺動(dòng)脈導(dǎo)管的風(fēng)險(xiǎn)。
 
Mixed Results in PAC Trial
 
The results of a large clinical trial called ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) revealed no deaths related to the use of a pulmonary artery catheter (PAC) and no increase in hospitalizations but did suggest that a PAC should not be routinely used to guide therapy.

A PAC is a thin catheter inserted into a neck vein and passed through the right side of the heart into a pulmonary artery in order to measure pressures and flows from the right side of the heart and the lungs. A tiny balloon is inflated to allow the measurement of pressures from the left side of the heart. A PAC is used in 3-5% of heart-failure patients who are hospitalized. Doctors also use a PAC to individualize medications for each patient and gauge their effects on heart function and symptoms.

ESCAPE involved 433 patients at 26 sites. The primary goal was to evaluate whether the increased precision offered by a PAC regarding heart and lung pressures results in improved patient survival and reduced time spent in the hospital over six months, compared with other therapies based on clinical assessment of physical signs and symptoms.

“We know that patients who received a PAC felt better, but then why didn’t they have fewer deaths or hospitalizations?” asked principal investigator Dr. Lynne Stevenson, of Brigham and Women’s Hospital (Boston, MA, USA). Dr. Stevenson believes the answer may lie in the fact that there was a big variation in how PAC information was used to treat patients. The researchers are conducting an in-depth analysis of the echocardiogram data in the trial, which may suggest some ways to adjust therapy without the risks of a PAC.