冠状动脉旁路移植术患者体外循环后早期右心室功能的变化  

Changes in right ventricular function in the early stage after cardiopulmonary bypass in patients undergoing coronary artery bypass grafting

作　　者：赵雅梅[1] 史宏伟[1] 缪娟娟[1] 王振红[1] 葛亚力[1] 魏海燕[1] 陈鑫 

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)麻醉科,210006 [2] 南京市心血管病医院心胸外科

出　　处：《中华麻醉学杂志》2014年第8期937-939,共3页Chinese Journal of Anesthesiology

摘　　要：目的 评价冠状动脉旁路移植术患者体外循环后早期右心室功能的变化.方法 择期体外循环下行左侧冠状动脉旁路移植术的冠心病患者18例,性别不限,ASA分级Ⅱ或Ⅲ级,NYHA心功能分级Ⅱ或Ⅲ级,年龄50 - 80岁,体重51 - 96 kg,左室射血分数≥50％.锯胸骨前（T1）和体外循环结束后5 min（T2）时记录血流动力学指标和心输出量（CO）,采用食管超声心动图监测右心室功能各指标：三尖瓣环收缩期位移（TAPSE）、右心室面积变化分数（RVFAC）、三尖瓣环等容收缩期峰值速度（IVV）、射血期峰值速度（St）、舒张早期峰值速度（Et）、舒张晚期峰值速度（At）、三尖瓣舒张早期血流峰值速度（E）,并计算E/Et比值和Et/At比值.结果 与T1时比较,T2时TAPSE、IVV、St、RVFAC、CO、E、Et和At增加（P＜0.05或0.01）,血流动力学指标、E/Et比值、Et/At比值差异无统计学意义（P＞0.05）.结论 冠状动脉旁路移植术患者CPB后早期右心室收缩功能明显提高,舒张功能总体上无明显改善.Objective To evaluate the changes in the right ventricular systolic and diastolic function during the early period after cardiopulmonary bypass （CPB） in patients undergoing coronary artery bypass grafting （CABG）.Methods Eighteen ASA physical status Ⅱ or Ⅲ patients of both sexes,with coronary heart disease （NYHA Ⅱ or Ⅲ）,aged 50-80 yr,weighing 51-96 kg,with left ventricular ejection fraction≥50%,scheduled for elective CABG under CPB,were enrolled in this study.Before splitting of sternum and at 5 min after termination of CPB,the parameters of hemodynamics,cardiac output （CO）and variables of right ventricular function （using transesophageal echocardiography） including tricuspid annular plane systolic excursion （TAPSE）,right ventricular fractional area change （RVFAC）,tricuspid annular peak velocity during isovolumic contraction （IVV）,peak velocity during ejection phases （St）,early diastolic peak velocity （Et）,late diastolic peak velocity （At）,E/Et ratio and Et/At ratio were recorded.Results Compared with the baseline value before splitting of sternum,TAPSE,IVV,St,RVFAC,CO,E,Et and At were significantly increased,and no significant change was found in the parameters of hemodynamics and E/Et and Et/At ratios at 5 min after termination of CPB.Conclusion For the patients undergoing CABG,the right ventricular systolic function is significantly enhanced,and there is no obvious improvement in the right ventricular diastolic function during the early period after CPB.

关 键 词：冠状动脉分流术 心脏功能试验 心肺转流术 

分 类 号：R654.2[医药卫生—外科学]