全髋关节置换骨水泥注入前后无创血流动力学参数监测  

Noninvasive hemodynamics monitoring in total hip replacement before and after cement implantation

作　　者：朱云章[1] 王文杰[1] 赵平[2] 

机构地区：[1]沈阳市骨科医院麻醉科,辽宁省沈阳市110044 [2]沈阳体育学院,辽宁省沈阳市110102

出　　处：《中国组织工程研究与临床康复》2008年第13期2409-2412,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：目的:观察全髋关节置换应用骨水泥充填前后心脏和外周血管功能的变化,并比较无创心功能监测仪与传统肺动脉漂浮导管监测血流动力学指标变化的作用及差异。方法:选择2006-03/2007-07沈阳市骨科医院收治的心功能Ⅰ～Ⅱ级,择期行全髋关节置换60例患者,分为骨水泥组30例和非骨水泥组30例。全部采用连续硬膜外麻醉,右侧颈内静脉穿刺,放置动脉漂浮导管,连接监测仪,监测心输出量、外周血管阻力。多功能监护仪监测心电图,动脉血压,脉搏氧饱和度。连接无创血流动力学监测仪,测定心输出量、外周血管阻力、心脏加速度指数、胸腔液体总量等血流动力学参数。同时做血气分析,测定动脉血氧分压、氧饱和度、二氧化碳分压。结果:①骨水泥组动脉血氧分压、动脉血氧饱和度、收缩压和舒张压在注入骨水泥后10,15min时显著下降(P<0.05)。动脉血二氧化碳分压没有明显变化。②两种方法监测骨水泥组注入骨水泥后10,15min的心输出量、外周血管阻力均低于注入骨水泥前(P<0.05)。胸腔液体总量在注入骨水泥后10,15min高于注入骨水泥前(P<0.05)。③在各时间点通过肺动脉漂浮导管和无创血流动力学检测系统测定心输出量值和外周血管阻力均有很好的偏性和相关性(P<0.05)。结论:全髋关节置换应用骨水泥充填对心脏收缩功能及外周血管功能有明显的抑制作用。无创血流动力学检测系统与肺动脉漂浮导管所测得血流动力学参数在每个时间点都具有很好的偏性和相关性。AIM： To observe the effects of cement on heart and peripheral vascular functions during total hip replacement and compare the effects of noninvasive monitor and traditional pulmonary artery floating catheter on hemodynamics. METHODS： Sixty patients with heart function Ⅰ - Ⅱ who underwent total hip replacement in Shenyang Orthopaedics Hospital between March 2006 to July 2007 were selected, and divided into cement group （n =30） and no-cement group （n =30）. Under continuous epidural anesthesia, all patients underwent fight internal jugular vein puncture, and pulmonary artery floating catheter was placed and connected with monitoring to monitor the cardiac output （CO） and systemic vascular resistance index （SVRI）. In addition, electrocardiogram （ECG）, arterial blood pressure （BP） and pulse O2 saturation （SATO2） were recorded by multi-function monitor. CO, SVRI, acceleration index （ACI） and thoracic fluid content （TFC） were recorded with noninvasive hemodynamics monitor. Blood gas analyses were also performed to detect arterial partial pressure of oxygen （PaO2）, SATO2, and carbon dioxide partial pressure （PaCO2）. RESULTS： （1）PaO2, SATO2, diastolic blood pressure and systolic blood pressure in cement group decreased significantly 10 and 15 minutes after cement implantation （P 〈 0.05）. PaCO2 had no significantly alterations. （2）Both monitoring methods showed that CO and SVRI in cement group decreased significantly 10 and 15 minutes after cement implantation than before implantation （P 〈 0.05）. TFC markedly increased 10 and 15 minutes after cement implantation than before implantation （P 〈 0.05）. （3）Bias and correlation of CO and SVRI were significant （P 〈 0.05） between noninvasive hemodynamics monitor and pulmonary artery floating catheter at any time point. CONCLUSION： Cement inhibits myocardial contraction and peripheral vascular function during total hip replacement. There are significant bias and correlation in hemodynamics p

关 键 词：无创血流动力学 髋关节置换术 骨科植入体 

分 类 号：R681[医药卫生—骨科学]