压力记录分析法用于小儿法洛四联症根治术中循环能量效率研究  

Pressure recording analytical method monitoring hemodynamic efficiency in children with tetralogy of Fallot undergoing surgery correction

作　　者：韩丁[1] 罗毅[2] 贾清彦[3] 汪晓南[3] 李稼[4] 欧阳川[3] 

机构地区：[1]首都儿科研究所附属儿童医院麻醉科,100020 [2]首都儿科研究所附属儿童医院心脏外科,100020 [3]首都医科大学附属北京安贞医院麻醉科 [4]首都儿科研究所临床病理生理研究室

出　　处：《心肺血管病杂志》2016年第8期623-627,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:应用压力记录分析法(PRAM),以室间隔缺损(VSD)修补术患儿为对照,观察法洛四联征(TOF)根治术中循环能量效率的变化规律。方法:本研究组共纳入96例,其中行VSD修补术的患儿50例(VSD组)及TOF根治术的患儿46例(TOF组)。入室后常规麻醉诱导,气管插管,桡动脉穿刺置管,常规静脉复合维持麻醉。通过Most Care监测仪分析桡动脉压力波形,监测切皮前(T0)、切开心包后(T1)、拔除主动脉导管后(T2)、术毕(T3)的HR、重脉压(Dicp)、每搏量指数(SVI)、心指数(CI)、体循环阻力指数(SVRI)、压力升支最大斜率(dp/dt)和循环能量效率(CCE),计算相应时间点的左心室收缩末弹性(Ees)、左心室收缩末动脉弹性(Ea)和心室-动脉偶联(VAC)。结果:两组患儿的一般情况差异无统计学意义。VSD组、TOF组内对比,CCE前者在T2、T3比T0均显著降低(P<0.01),在T3比T2显著增高(P<0.01),后者CCE在T2比T0显著降低(P<0.05)。Ees在T1(前者P<0.05,后者P<0.01)、T2、T3(均P<0.01)比T0两组均显著增高。Ea在T2、T3比T0两组均显著增高(P<0.01),TOF组VAC在T2、T3比T0显著降低(P<0.01)。与VSD组比较,TOF组CCE在T0及T1(P<0.01)、T3(P<0.05)时显著降低,VAC在T3时显著降低(P<0.01),Ees在T0、T1、T2(P<0.05)及T3(P<0.01)显著降低。CCE与VAC在T0、T1、T2、T3时均呈明显正相关(P<0.001)。结论:在小儿先天性心脏病手术中,RPAM法可以客观反映循环能量效率变化。TOF组循环能量效率低下,其特点为心脏畸形矫治术前是以右心和肺循环功能低下为主,心脏畸形矫治术后左心系统功能低下更明显,应更加注重改善左心室弹性与动脉弹性的匹配关系。Objective： To compare Tetralogy of Fallot children（ TOF） with control ventricular septal defect（ VSD） children during correction surgery on change of hemodynamic efficiency by using pressure recording analytical method（ PRAM）. Methods： 50 children（ 1. 3 ± 1. 0） years with VSD and 46 with TOF（ 1. 0 ±0. 8） years scheduled for complete repair were enrolled. In operation room,routine clinical anesthesia induction and tracheal intubation were performed,a catheter was inserted in radial artery,anesthesia was maintained with routine intravenous balanced anesthetics. HR,dicrotic pressure（ Dicp）,indexed stroke volume（ SVI）,CI,indexed systemic vascular resistance（ SVRI）,dp / dt,and cardiac cycle efficiency（ CCE） were recorded by Most Care device before surgical incision（ T0）,after pericardium cut（ T1）,after removal of aortic cannula（ T2）,and end of operation（ T3）. Left ventricular end-systolic elastance（ Ees） 、left ventricular end-systolic arterial elastance（ Ea） and ventricular-arterial coupling（ VAC） at according time were calculated. Results： General information between the two groups was not significantly different. Intra VSD and TOF group comparison,CCE in the former was lower at T2 and T3 compared with T0（ P 0. 01）,higher at T3 compared with T2（ P 0. 01）,CCE in the latter was lower at T2 compared with T0（ P 0. 05）. Ees was higher at T1（ the former P 0. 05,the latter P 0. 01） T2 and T3（ P 0. 01 for all） compared with T0. Ea was higher at T2 and T3 compared with T0（ P 0. 01） in both groups. Intra TOF group VAC was lower at T2 and T3 compared with T0（ P 0. 01）. As compared with VSD group,in TOF group CCE was lower at T0,T1（ P 0. 01） and T3（ P 0. 05）,VAC was lower at T3（ P 0. 01）,Ees was lower at T0,T1,T2（ P 0. 05） and T3（ P 0. 01）.CCE was significantly correlated with VAC at T0,T1,T2 and T3（ P 0. 001）. Conclusion： RPAM could track hemodynamic efficiency changes in children with congenital heart

关 键 词：先天性心脏病 法洛四联症 循环能量效率 心脏手术 压力记录分析法 

分 类 号：R54[医药卫生—心血管疾病]