冠状动脉旁路移植术围手术期右心室容量的变化及其意义  

Significance of right ventricular volume changes during coronary artery bypass grafting

作　　者：肖洁[1] 王祥瑞[1] 周洁[1] 孙大金[1] 

机构地区：[1]上海第二医科大学附属仁济医院麻醉科,200127

出　　处：《上海医学》2004年第7期479-481,共3页Shanghai Medical Journal

摘　　要：目的　应用新型有创血流动力学监测仪观察冠状动脉旁路移植术 (CABG)围术期右心室容量的变化 ,并探讨其意义。方法　 4 0例冠心病患者行CABG ,连续监测患者的心排血量 (CO)、心脏指数 (CI)、平均动脉压 (MAP)、肺毛细血管楔压 (PCWP)、全身血管阻力 (SVR)、右心射血分数 (RVEF)、右室舒张末容积 (RVEDV)、右室收缩末容积 (RVESV)等血流动力学参数。结果　与术前相比 ,CO、CI、RVEF在体外循环转机前呈下降趋势 ,体外转机停机后CO、CI、RVEF、RVEDV值逐渐上升 (P <0 .0 1) ,术后早期再次下降 ,至术后 8h又逐渐升高 ;SVR在体外循环转机前也有所下降 (P <0 .0 5 ) ,在术后早期逐步升高 ,后又下降。结论　行CABG手术的患者在围术期右心功能代偿性增加 ;术后早期患者均出现不同程度低心排血量的表现 ,但很快就能被机体代偿。右心容量监测有助于围术期监测 。Objective To evaluate the perioperative changes of right ventricular volume in patients with coronary artery bypass grafting (CABG) through a new hemodynamic monitor. Methods By continuous monitoring of CO,CI,MAP,PCWP,SVR,RVEF,RVEDV,RVESV using Vigilance CCO/SvO 2 monitor (USA) in 40 patients underwent CABG. Results CO, CI, RVEF values were some what low in compared with those in the preoperative period before the bypass stage (P<0.05). They were then increased in the post-bypass stage (P<0.01);whereas during the early postoperative period, CO, CI, RVEF and RVEDV were gradually increased; SVR also decreased in the pre-bypass stage (P<0.05); after CABG, it began to increase till the operation, varying degrees then it started to decrease again. Conclusion During perioperative stage of CABG, patients' right ventricular function are enforced and low cardiac output manifestations were shown during the early stage of postoperative period, but rapidly overcome by body compensation. The right ventricular volume monitor is helpful for perioperative monitoring and guides the clinical management.

关 键 词：冠状动脉旁路移植术 围手术期 右心室容量 冠心病 心排血量 心脏指数 平均动脉压 

分 类 号：R654.2[医药卫生—外科学]