非停跳冠状动脉搭桥患者早期不同入液量对搭桥期间血流动力学及组织氧合的影响  

Effects of different fluid volume on hemodynamics and tissue oxygenation during early stage of off-pump coronary artery bypass grafting

作　　者：包娜仁[1] 程佳音[1] 马虹[1] 

机构地区：[1]中国医科大学附属第一医院麻醉科,辽宁沈阳110004

出　　处：《中国现代医学杂志》2016年第3期101-105,共5页China Journal of Modern Medicine

摘　　要：目的观察非停跳冠状动脉搭桥（OPCABG）患者早期不同入液量对搭桥期间血流动力学及组织氧合的影响。方法将OPCABG患者随机分为两组,每组20例。常规麻醉诱导和维持。从入室至游离乳内动脉前,A组以2～3 ml/（kg·h）、B组以5～7 ml/（kg·h）的速度输注生理盐水。记录患者术前（T_0）、游离乳内动脉前（T_1）、前降支远端吻合（T_2）、右冠状动脉远端吻合（T_3）、回旋支远端吻合（T_4）、搭桥结束患者体位调至水平后（T_5）各时间的平均动脉压（MAP）、心率（HR）、心输出量（CO）、每搏量变异度（SVV）、中心静脉压（CVP）。T_1和T_4时的中心静脉血氧饱和度（Scv O_2）、动脉血乳酸,T_0～T_5时患者去甲肾上腺素（NE）和肾上腺素（E）总用量、尿量,入监护室后第1天的血乳酸峰值、肌酐峰值。结果两组患者年龄、性别、体重、左室射血分数、术前心梗例数、手术时间以及T_0与T_1时血流动力学指标比较,差异无统计学意义。A组患者T_2、T_4、T_5时MAP明显低于T_0（P〈0.05）,T_4、T_5时MAP低于B组,差异无统计学意义。T_2～T_5时A组HR明显低于B组（P〈0.05）。搭桥期间两组CO明显低于术前（P〈0.05）,T_2～T_4时A组CO逐渐下降,而B组CO无明显波动,T_3～T_5时B组CO高于同时间的A组（P〈0.05）。两组CVP在T_2～T_4随时间推移呈逐渐上升趋势,明显高于术前水平（P〈0.05）,T_2时A组患者CVP高于B组（P〈0.05）。两组SVV变化无明显规律。A组患者术中应用血管活性药物总量、T_4时乳酸水平、监护室乳酸峰值高于B组（P〈0.05）,T_4时Scv O_2低于B组（P〈0.05）。术中尿量明显少于B组,术后早期肌酐峰值高于B组（P〈0.05）。结论搭桥前轻度限制液体输入,达到早期目标导向性液体治疗目标,在搭桥期间维持血流动力学平稳、保证组织灌注和氧供、减少血管收缩药的依赖性方面具有明显优势。Objective To observe the effect of different fluid volume on hemodynamics and tissue oxygenation in the early stage of off-pump coronary artery bypass grafting （OPCABG）. Methods Patients with OPCABG were randomly divided into groups A and B with 20 cases in each group. Anesthesia induction and mainte- nance were conducted routinely. Patients were infused with normal saline at the speed of 2-3 ml/（kg·h） in the group A and 5-7 ml/（kg·h） in the group B from the time of entering the operation room to the free of inter- nal mammary artery. Patients＇ mean arterial pressure （MAP）, heart rate （HR）, cardiac output （CO）, stroke vol- ume variation （SVV） and central venous pressure （CVP） were recorded at six time points including the time of entering the operation room （To）, before the free of internal mammary artery （T1）, at the anastomosis of anterior descending braneh （T2）, the anastomosis of the distal end of fight eoronary artery （T3） and distal end of eireum- flex coronary artery （T4）, and immediatly after anastomosis of all the arteries （T5）. Central venous oxygen satura- tion （ScvO2） and arterial laetate were recorded at T1 and T4. The urine volume and the total amount of nore- pinephrine （NE） and epinephrine （E） used from To to Ts were summarized. The peak values of arterial lactate and creatinine on the first day in the Intensive Care Unit were also recorded. Results There were no signifi- cant differenees between both groups in age, sex, body weight, left ventricular ejection fraction, the ease num- ber of preoperative myoeardial infaretion, operation time or the hemodynamie indexs at To and T1. MAP at T2, T4 and T5 was significantly lower than that at To in the group A. Athough MAP of the group A at T4 and T5 was lower than that of the group B, there was no statistical difference. From T2 to T5, HR in the group A was significantly lower than that in the group B （P 〈 0.05）. CO of the patients in both groups during bypass grafting was sig

关 键 词：冠状动脉搭桥术 血流动力学 限制性输液 目标导向性液体治疗 

分 类 号：R614.2[医药卫生—麻醉学] R654.2[医药卫生—外科学]