胸腔内血容积和全心舒张末期容积监测肝移植术患者心脏前负荷的准确性  

Accuracy of perioperative cardiac preload monitoring by global end-diastolic volume and intrathoracic blood volume in orthotopic liver transplantation

作　　者：张鸿飞[1] 徐世元[1] 叶小平[1] 周健[1] 梁启波[1] 许平[1] 张新建[1] 

机构地区：[1]南方医科大学珠江医院麻醉科,广东广州510282

出　　处：《南方医科大学学报》2010年第7期1577-1579,共3页Journal of Southern Medical University

基　　金：广东省科技攻关项目(2005B30601005)

摘　　要：目的评价全心舒张末期容积(GEDV)和胸腔内血容积(ITBVTPTD)在肝移植术围术期的应用价值与意义。方法择期肝移植术患者8例,年龄42～50岁,ASAⅢ～Ⅳ级。经股动脉及颈内静脉分别置入PiCCOplus热稀释导管和CCO导管,监测GEDV、ITBV及每搏输出量(SVPAC,经CCO肺动脉导管测得)、肺动脉阻塞压(PAOP)、中心静脉压(CVP)等参数。于麻醉诱导前(T0)、无肝期前10min(T1)、无肝期10min(T2)、新肝期10min(T3)及术毕(T4)采集数据。结果与T0、T1、T3及T4相比,T2时点GEDV与ITBV均明显降低(P<0.05);与T0及T1相比,T2时点SVPAC显著降低(P<0.05)。GEDV、ITBV与SV正相关(P<0.01),PAOP、CVP与SV不相关。PAOP、CVP与GEDV、ITBV不相关。结论 GEDV与ITBV较PAOP、CVP能更准确反映心脏前负荷的变化。Objective To investigate the clinical value of global end-diastolic volume （GEDV） and intrathoracic blood volume （ITBV） in perioperative monitoring of the cardiac preload in patients undergoing orthotopic liver transplantations （OLT）. Methods Eight ASA III or IV patients aged 42-50 years undergoing OLT without venovenous bypass under general anesthesia were enrolled in this study. Before the induction, a thermodilution femoral artery catheter was inserted into the femoral artery under local anesthesia and connected to a PiCCOplus system to monitor ITBV and GEDV. A CCO catheter was inserted into the right internal jugular vein to monitor the pulmonary artery obstruction pressure （PAOP）, central venous press （CVP） and stroke volume （SVPAC）. Anesthesia was induced with a combination of midazolam （0.1 mg/kg）, propofol （1 mg/kg） and fentanyl （3 μg/kg）. Pipecuronium （0.1 mg/kg） was given to facilitate naso-endotracheal intubation. Before anesthesia （T0） and at 10 min before the anhepatic phase （T1）, 10 min after anhepatic phase （T2）, 10 min after neohepatic phase （T3） and at the end of surgery （T4）, all the TPTD and CCO parameters were measured by injecting 10 ml cold saline solution （below 8 ℃） via the distal port of the central venous catheter. Results ITBV and GEDV at T2 were significantly lower than those at T0, T1, T3 and T4 （P0.05）. SVPAC at T2 was dramatically decreased compared with that at T0 and T1 （P0.05）. The changes in the pressure preload parameters of the pulmonary artery catheter （PAOP and CVP） did not correlate to the changes in SVPAC, whereas the changes in the volume preload parameters （ITBV and GEDV） of the TPTD was significantly correlated to the changes in SVPAC （P0.01）. PAOP and CVP did not correlate to the changes in ITBV and GEDV. Conclusion ITBV and GEDV are more reliable than PAOP and CVP in perioperative monitoring of the cardiac preload in patients undergoing OLT.

关 键 词：原位肝移植术 经肺温度稀释法 前负荷 胸腔内血容积 全心舒张末期容积 

分 类 号：R657.3[医药卫生—外科学]