文章摘要
非心肺转流冠状动脉旁路移植术中心脏循环效率变化趋势的分析
Analysis of cardiac cycle efficiency in the surgical operation of off-pump coronary artery bypass grafting
  
DOI：10.12089/jca.2018.10.010
中文关键词: 非心肺转流冠状动脉旁路移植术  心脏循环效率  微创血流动力学  压力波形分析技术
英文关键词: Off-pump coronary artery bypass grafting  Cardiac cycle efficiency  Microinvasive hemodynamics  Pressure recording analysis method
基金项目:北京市医院管理局临床医学发展专项经费资助(ZYLX201810)
作者单位E-mail
方英伦 100029,首都医科大学附属北京安贞医院,北京市心肺血管疾病研究所麻醉科  
李会芳 河南大学第一附属医院麻醉科  
吕誉芳 100029,首都医科大学附属北京安贞医院,北京市心肺血管疾病研究所麻醉科  
王慧敏 100029,首都医科大学附属北京安贞医院,北京市心肺血管疾病研究所麻醉科  
马骏 100029,首都医科大学附属北京安贞医院,北京市心肺血管疾病研究所麻醉科  
赵丽云 100029,首都医科大学附属北京安贞医院,北京市心肺血管疾病研究所麻醉科 zhaoliyun1007@163.com 
摘要点击次数: 2751
全文下载次数: 836
中文摘要:
      
目的 采用压力波形分析技术(pressure recording analytical method, PRAM)分析非心肺转流冠状动脉旁路移植术(off-pump coronary artery bypass grafting, OPCABG)中心脏循环效率(cardiac cycle efficiency, CCE)等血流动力学参数的变化趋势。
方法 选择2017年3—9月拟于全麻下行择期OPCABG患者43例,男36例,女7例,年龄45～75岁,ASA Ⅱ或Ⅲ级,心功能Ⅱ或Ⅲ级。应用MOSTCARE监护仪(核心技术为PRAM)监测患者麻醉结束后(T1)、吻合前降支(T2)、吻合对角支(T3)、吻合回旋支(T4)、吻合后降支(T5)、搭桥完成后(T6)、术毕(T7)时的血流动力学参数,包括CCE、最大压力梯度(dp/dt)、MAP、HR、心脏指数(cardiac index, CI)、每搏指数(stroke volume index,SVI)、心搏量变异度(stroke volume variability, SVV)、外周血管阻力指数(systemic vascular resistance index, SVRI)。
结果 与T1时比较,T2—T6时CCE明显降低(P<0.01)。与T1时比较,T2—T7时dp/dt、CI、SVI、SVRI明显降低（P<0.05）；HR明显增快，SVV明显升高(P<0.05),但仍处于正常范围内。T2—T6时CCE与dp/dt呈明显正相关(P<0.05);T1—T4、T7时CCE与CI、SVI呈明显正相关,与SVRI呈明显负相关(P<0.01);T1、T7时CCE与SVV呈明显负相关(P<0.01)。
结论 在靶血管吻合过程中,尽管CI、SVI、SVRI等参数仍在正常范围,但CCE却有明显降低,且恢复较其他血流动力学参数缓慢。
英文摘要:
      
Objective To study the variation tendency of hemodynamic parameters such as cardiac cycle efficiency (CCE) in the surgical operation of off-pump coronary artery bypass grafting using Pressure Recording Analysis Method (PRAM).
Methods Forty-three patients for selective off-pump coronary artery bypass grafting (OPCABG), 36 males and 7 females, aged 45 - 75 years, falling into ASA physical status Ⅱ or Ⅲ, cardiac function grade Ⅱ or Ⅲ, were selected for general anesthesia from March to September 2017. The MOSTCARE monitor (core technology PRAM) was used to monitor the hemodynamic parameters at various time points. The cardiac cycle efficiency (CCE), maximum pressure gradient (dp/dt), mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), stroke volume index (SVI), stroke volume variability (SVV) and systemic vascular resistance index (SVRI) were monitored at the end of anesthesia (T1), anastomosis of anterior descending branch (T2), diagonal branch (T3), circumflex branch (T4), posterior descending branch (T5), after bypass (T6), and end of procedure (T7).
Results Compared with T1, CCE was significantly decreased at T2 - T6 (P < 0.01). Compared with T1, dp/dt, CI, SVI and SVRI were all decreased significantly at T2 - T7(P<0.05). HR and SVV were increased significantly at T2 - T7(P < 0.05), but HR and SVV still stayed in the normal range. There was a positive correlation between CCE and dp/dt at T2 - T6 (P < 0.01). CCE was positively correlated with dp/dt but negatively correlated with SVRI at T1 - T4 and T7 (P < 0.01) and negatively correlated with SVV at T1 and T7 (P < 0.01).
Conclusion In the process of target vessel anastomosis, although CI, SVI, SVRI and other parameters are still in the normal range, CCE has been significantly reduced to a negative value, and at the time point of the anastomosis of posterior descending branch CCE decreases to the lowest and recovers more slowly than other hemodynamic parameters.
查看全文   查看/发表评论  下载PDF阅读器
关闭