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| 术前容量治疗对微创冠状动脉搭桥患者微血管反应性的影响 |
| Effect of preoperative fluid therapy on microvascular reactivity in patients with minimally invasive coronary artery bypass |
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| DOI：10.12089/jca.2023.08.003 |
| 中文关键词: 微创冠状动脉搭桥 微血管反应性 组织氧恢复斜率 目标导向液体治疗 |
| 英文关键词: Minimally invasive coronary artery bypass Microvascular reactivity Tissue oxygen saturation recovery slope Goal-directed fluid therapy |
| 基金项目:中国初级卫生保健基金（YLGX-WS-2020002） |
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| 中文摘要: |
目的 探讨术前容量治疗对微创冠状动脉搭桥（MIDCAB）患者微血管反应性的影响。
方法 选择择期行MIDCAB患者82例，男57例，女25例，年龄≥18岁，BMI 15～31 kg/m2，ASA Ⅲ级，NYHA分级Ⅰ或Ⅱ级。采用随机序列号法将患者分为两组：容量治疗组（T组）和对照组（C组），每组41例。T组麻醉诱导前根据被动抬腿试验，以ΔSV≥16%为目标进行术前容量治疗；C组术前不进行容量治疗。记录麻醉诱导前30 min、麻醉诱导后30 min的组织氧饱和度（StO2）、组织氧恢复时间（tM）、组织氧恢复斜率（RecStO2）、组织氧下降斜率（DesStO2）、SBP、DBP、MAP、Hb、静脉血氧饱和度（SvO2）、动脉血氧饱和度（SaO2）、动脉血氧含量（CaO2）、静脉血氧含量（CvO2）、氧摄取率（OER）、pH和Lac。
结果 与麻醉诱导前30 min比较，麻醉诱导后30 min T组MaxStO2和MinStO2明显升高，tM明显缩短，DesStO2明显降低（P<0.05）；C组MaxStO2和MinStO2明显升高，tM明显延长，RecStO2和DesStO2明显降低（P<0.05）。麻醉诱导前后30 min两组BaseStO2差异无统计学意义。与C组比较，麻醉诱导后30 min T组tM明显缩短，RecStO2明显升高，SBP、DBP、MAP明显升高，Lac明显降低（P<0.05）。
结论 基于被动抬腿试验的术前容量治疗可改善麻醉诱导后微创冠状动脉搭桥患者微血管反应性。 |
| 英文摘要: |
Objective To analyze theeffect of preoperative fluid therapy on microvascular reactivity in patients with minimally invasive direct coronary artery bypass (MIDCAB).
Methods Eighty-two patients with MIDCAB, 57 males and 25 females, aged ≥ 18 years, BMI 15-31 kg/m2, ASA phycsical status Ⅲ, NYHA Ⅰ-Ⅱ, were randomly divided into two groups: fluid therapy group (group T) and control group (group C), 41 patients in each group. Preoperative volume therapy was performed according to the test of passive leg-raising with ΔSV ≥ 16% as the target in group T. No volume therapy was performed before anesthesia in group C. The values of SBP, DBP, MAP, tissue oxygen saturation (StO2), tissue oxygen recovery time (tM), StO2 recovery slope (RecStO2), StO2 decline slope (DesStO2), Hb, venous oxygen saturation (SvO2), arterial oxygen saturation (SaO2), arterial oxygen content (CaO2), venous oxygen content （CvO2）, oxygen extraction ratio (OER), pH, and Lac were recorded 30 minutes before and after anesthesia induction.
Results Compared with 30 minutes before anesthesia induction, MaxStO2 and MinStO2 were significantly increased, tM was significantly shortened, and DesStO2 was significantly decreased 30 minutes after anesthesia induction in group T (P < 0.05), MaxStO2 and MinStO2 were significantly increased, tM was significantly prolonged, RecStO2 and DesStO2 were significantly decreased 30 minutes after anesthesia induction in group C (P < 0.05). There was no significant difference in BaseStO2 between the two groups 30 minutes before and after anesthesia induction. Compared with group C, tM was significantly shortened, RecStO2, SBP, DBP, and MAP were significantly increased, Lac was significantly decreased in group T (P < 0.05).
Conclusion Preoperative volume therapy based on the passive leg-raising test improved microvascular reactivity in patients with minimally invasive direct coronary artery bypass. |
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