心脏手术后桡动脉-股动脉压力阶差相关危险因素分析  

Analysis of risk factors involved in radial-femoral artery pressure difference after cardiac surgery

作　　者：袁冬喜 孙杰 

机构地区：[1]南京医科大学第一附属医院麻醉科,江苏省210029

出　　处：《江苏医药》2015年第20期2429-2432,共4页Jiangsu Medical Journal

摘　　要：目的回顾性分析心肺转流(CPB)心脏手术后桡动脉-股动脉收缩压压力阶差(SBPDR-F)的相关危险因素。方法 42例CPB心脏手术患者在停止CPB后出现了明显的SBPDR-F。其中,SBPDR-F<30mmHg者29例(A组),SBPDR-F≥30mmHg者13例(B组)。测量主动脉内径,记录并分析麻醉诱导后(T1)、停机时(T2)、手术结束(T3)和术后第1天(T4)时的相关血流动力学指标。结果 A组患者主动脉内径小于B组[(27.5±4.1)mm vs.(32.6±5.4)mm](P<0.01)。CPB期间,A组去氧肾上腺素的用量少于B组[(2.1±1.2)mg vs.(4.0±1.2)mg](P<0.01)。T2和T3时两组患者的桡动脉压低于股动脉压,且B组更明显(P<0.01);T4时的SBPDR-F缩小。T2时SBPDR-F发生的相关因素为肺毛细血管楔压(r=0.948,P<0.05)、去氧肾上腺素(r=2.347,P<0.01)、心脏指数(r=-9.432,P<0.01)、中心静脉压(r=1.710,P<0.01)和主动脉内径(r=0.437,P<0.01)。结论直接中心动脉测压有助于了解心脏手术中的SBPDR-F。使用正性肌力药物改善心肌收缩力、避免大剂量血管收缩剂和适当的液体治疗可减少SBPDR-F。Objective To retrospectively analyze the risk factors involved in radial-femoral artery systolic blood pressure difference（SBPDR-F）after cardiac surgery under cardiopulmonary bypass（CPB）.Methods Forty-two patients after cardiac surgery under CPB showed remarkable SBPDR-F,of whom 29cases（group A）had SBPDR-F〈30mm Hg,and 13cases（group B）had SBPDR-F≥30mm Hg.The inner diameter of aorta was measured.The heamodynamic parameters were recorded after anesthesia induction（T1）,during discontinuing of CPB（T2）,at the end of surgery（T3）and on the first postoperative day（T4）.Results The inner diameter of aorta was less in group A than that in group B[（27.5±4.1）mm vs.（32.6±5.4）mm]（P〈0.01）.During CPB,phenylephrine usage was less in group A than that in group B[（2.1±1.2）mg vs.（4.0±1.2）mg]（P〈0.01）.The radial artery systolic blood pressures at T2 and T3were lower than the femoral in both groups,which were more in group B（P〈0.01）and the SBPDR-Fwas shortened at T4.The factors related to SBPDR-F were pulmonary capillary wedge pressure（r=0.948,P〈0.05）,phenylephrine（r=2.347,P〈0.01）,cardiac index（r=-9.432,P〈0.01）,central venous pressure（r=1.710,P〈0.01）and the inner diameter of aorta（r=0.437,P〈0.01）.Conclusion Measurement of the central artery pressure is helpful in understading the SBPDR-F in the patients undergoing cardiac surgery under CPB.Using inotropic agents to improve cardiac output,avoiding excessive vasoconstriction and adopting appropriate fluid therapy may reduce the SBPDR-F.

关 键 词：心肺转流 桡动脉压 股动脉压 心脏手术 

分 类 号：R614[医药卫生—麻醉学]