心肺转流后股-桡动脉压力阶差的影响因素  

Risk factors of femoral-radial artery pressure gradients after cardiopulmonary bypass

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作  者:许佩龙 孙杰[1,2] 丁正年 

机构地区:[1]南京医科大学第一附属医院 [2]江苏省人民医院麻醉科,210029

出  处:《临床麻醉学杂志》2014年第11期1065-1068,共4页Journal of Clinical Anesthesiology

摘  要:目的分析心脏手术心肺转流(CPB)后股-桡动脉压力阶差的影响因素。方法回顾分析2012年1~12月心脏手术患者412例,11例由于在术前存在桡-股动脉压力阶差而被剔除,根据CPB后是否出现股-桡动脉压力阶差将患者分为两组,其中138例(P组)出现股-桡动脉压力阶差,263例(N组)无阶差。采用多元线形回归分析股-桡动脉压力阶差的影响因素。结果两组麻醉诱导后的桡动脉和股动脉的SBP、DBP和MAP差异无统计学意义,但在停机时P组SBP、DBP和MAP明显低于N组(P〈0.05)。与N组比较,CPB结束时P组SVRI和PVRI明显升高,CI明显降低(P〈0.01)。多元线性回归结果提示,CI对收缩压差的影响,CI、CVP、SVRI对舒张压差的影响、CI、SVRI对平均动脉压差的影响有统计学意义(P〈0.01)。结论心脏手术患者出现股-桡动脉压力阶差时,认识到其影响因素,及时准确地监测主动脉根部压力对于选择停机的时机有重要参考作用。Objective To investigate the risk factors involved in femoral-radial artery pressuregradients after cardiac surgery.Methods In this retrospective study,we reviewed 412 patients,in 11 patients dut to the presence of preoperative radial and femoral artery pressure gradient were rejected.According to monitoring of femoral pressure and radial pressure grodients of the patients were divided into two groups 138 patients had femoral-radial artery pressure gradients after cardiopulmonary bypass(group P),but 263 were not(group N).Their hemodynamic datas and other demographic datas were analyzed.Results There were no differences in radial and femoral SBP,DBP,MAP between the two groups at the time point of anesthesia induction;that of group N immediate after discontinuation of CPB.SVRI and PVRI were higher in group P(P〈0.01).The SBP,DBP and MAP of radial artery in group P were significantly lower than those in group N at time of withdrawal of CPB.SVRI and PVRI were higher in group P,CI was lower in group P right after discontinuation of CPB compared with group N(P〈0.01).CVP was higher in group P than that in group N at baseline.There was no difference in HR,PCWP or PAP between the two groups at any time point.Multiple linear regression results suggest that the impact on systolic blood pressure gradients was CI;CI,CVP,SVRI affect diastolic blood pressure gradients,CI,SVRI affect mean arterial pressure were statistically significant.Conclusion Detecting the exact central artery pressure are very important when patients have artery pressure gradients after cardiac surgery.It is important to monitor the aortic root accurate pressure for choosing the chance of withdrawal of CPB.

关 键 词:心肺转流 压力阶差 桡动脉压 股动脉压 心脏功能 

分 类 号:R654.2[医药卫生—外科学] R614[医药卫生—临床医学]

 

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