漂浮导管在非停跳冠状动脉旁路移植术的应用分析  

Application of floating catheter in off-pump coronary artery bypass grafting

作　　者：孙鼐[1] 赵伟新[1] 

机构地区：[1]郑州大学附属郑州中心医院麻醉科,郑州450007

出　　处：《中国循证心血管医学杂志》2015年第3期362-364,共3页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的：探讨漂浮导管在非停跳冠状动脉旁路移植术的应用效果。方法选择2011年11月至2014年2月在郑州大学附属郑州中心医院心脏外科诊治的冠状动脉粥样硬化性心脏病（冠心病）患者72例，男性41例，女性31例，年龄45~76岁。随机分为治疗组（n=36）与对照组（n=36）。所有患者均在全麻下手术，经颈内静脉放置双腔肺动脉漂浮导管监测生命体征，对照组采用常规冠状动脉旁路移植术，治疗组采用非停跳冠状动脉旁路移植术。测定两组肺毛细血管嵌压（PCWP）、中心静脉压（CVP）、心率（HR）等。计算心脏指数（CI）、左心室每搏做功指数（LVSWI）、体循环血管阻力（SVR）。记录两组术中出血量、术中输液量、机械通气时间、ICU停留时间与术后住院时间。结果两组术前、术后即刻和术后12 h PCWP、CVP与HR值对比，差异无统计学意义（P均＞0.05）。两组术后12 h较术前PCWP、CVP和HR均升高，差异有统计学意义（P均＜0.05）。两组术前、术后即刻和术后12 h的CI、LVSWI和SVR值对比，差异无统计学意义（P均＞0.05）。两组术后较术前LVSWI升高，SVR降低，差异有统计学意义（P均＞0.05）。治疗组的机械通气时间、ICU停留时间与术后住院时间明显低于对照组，有统计学差异（P均＜0.05）。两组术中出血量和术中输液量对比差异无统计学意义（P均＞0.05）。结论漂浮导管在非停跳冠状动脉旁路移植术的应用能有效反应心脏的功能状态，值得推广应用。Objective To investigate the application efficacy of floating catheter in off-pump coronary artery bypass grafting （OPCABG）. Methods The patients with coronary heart disease （CHD, n=72, male 41, female 31 and aged from 45 to 76） were chosen from Nov. 2011 to Feb. 2014, and then randomly divided into treatment group and control group （each n=36）. All patients were implanted double-lumen pulmonary artery floating catheter for monitoring vital signs under general anesthesia condition. The control group was given routine coronary artery bypass grafting and treatment group, OPCABG. The changes of pulmonary capillary wedge pressure （PCWP）, central venous pressure （CVP） and heart rate （HR） were detected, cardiac index （CI）, LVSWI and systemic vascular resistance （SVR） were calculated, and blood loss, transfusion volume and mechanical ventilation time during operation, ICU stay time and postoperative hospitalization duration were recorded. Results The difference in PCWP, CVP and HR had no statistical significance between 2 groups before, immediate and 12 h after operation （all P〉0.05）. PCWP, CVP and HR increased in 2 groups 12 h after operation （all P0.05）. LVSWI increased and SVR decreased in 2 groups after operation （all P0.05）. Conclusion The application of floating catheter in OPCABG can effectively reflect cardiac functional status, which is worth to be popularized and applied.

关 键 词：漂浮导管 非停跳冠脉搭桥术 血液动力学 冠状动脉搭桥术 

分 类 号：R654.2[医药卫生—外科学]