每搏量变异度与校正左室射血时间作为不停跳冠脉搭桥手术容量管理指标的效果比较  

The efficacy comparison between off-pump coronary bypass surgeries with capacity management index using stroke volume variation and corrected left ventricular ejection time

作　　者：梁冰 曹阳 罗建华 张艳 王琳 刘家欣[2] LIANG Bing , CAO Yang, LUO Jian - hua,ZHANG Yan, WANG Lin, LIU Jia - xin.(Department of Anesthesia, Guangzhou Red Cross Hospital, Fourth Affiliated Hospital of Medical College, Jinan University, Guangzhou 510220, Guangdong, Chin)

机构地区：[1]广州市红十字会医院麻醉科,广东广州510220 [2]中山大学附属第一医院麻醉科,广东广州510080

出　　处：《广东医学》2018年第10期1488-1491,共4页Guangdong Medical Journal

基　　金：广州市卫生和计划生育科技一般引导项目(编号:20161A010018;20171A010256);广州市科学研究专项项目(编号:201707010491)

摘　　要：目的比较每搏量变异度(SVV)与校正左室射血时间(LVETc)用于不停跳(非体外循环)冠脉搭桥(OPCAB)术中容量管理指标的价值以及容量管理的氧合效果。方法择期OPCAB手术患者40例,ASAⅡ~Ⅲ级,随机分为两组,每组20例。SVV组(S组)以SVV为容量管理目标;LVETc组(L组)以LVETc为容量管理目标。S组:维持术中SVV在8%~12%。L组:当LVETc<0.35 s时,输注6%羟乙基淀粉3 m L/kg,LVETc>0.4 s时暂停补液。记录打开心包时(T0)、进行左前降支搭桥(T1)、钝缘支(T2)和后降支搭桥(T3)心脏位置固定后5 min的每搏量(SV)、心指数(CI)、每搏量指数(SVI)、全身血管阻力(SVR)和SVV。记录液体总量、手术时间、术中尿量、拔除气管导管时间,记录Lac、血糖,计算DO2I、VO2I。术毕记录血管活性药物总用量、心血管事件。结果两组手术时长、术中尿量、拔除气管导管时间差异无统计学意义(P>0.05)。S组的输液总量大于L组,S组各时间点SVR均低于L组(P<0.05),S组心指数(CI)在打开心包前和吻合前降支时高于L组,但SVI有降低趋势。虽然S组在T1、T2时间点DO2I较L组更高(P<0.05),但两组VO2I差异不明显,代谢指标Lac以及术后心血管事件亦无显著差异。L组术中维持血流动力学稳定使用去氧肾上腺素的患者及平均用量更多。结论对于OPCAB术,SVV和LVETc都能够有效指导围术期容量治疗,防止心脏不良事件的发生。但以LVETc为容量管理目标可以减少输液总量,在维持灌注目标的同时,减少组织间隙液体负荷,对更快恢复脏器及肠道功能以及快速康复有利。Objective To compare the effects of stroke volume variation(SVV） and correct left ventricular ejection time(LVETc） on volumetric therapy in off-pump coronary artery bypass surgery(OPCAB）. Methods Twenty patients scheduled to elective coronary bypass surgery were randomly allocated into 2 groups,SVV group(Group S,n =20） and LVETc group(Group L,n = 20）. Group S received goal-directed fluid therapy based on stroke volume variation,whereas Group L received traditional fluid therapy based on correct left ventricular ejection time. The crystalloid requirements,colloid requirements,banked blood requirements,total fluid volume infuse,urinary output,bleeding volume,vasoactive drugs and hemodynamics during the operation were recorded. Results There was no significant difference in duration of surgery,intraoperative urine output or extubation duration between the 2 groups. The SVR in Group S was significantly lower than that in Group L(P〈 0. 05）. The CI in Group S was significantly higher than Group L before opening pericardium and anastomosis. Stroke volume index(SVI） had a decreasing trend. There was no significant difference between the two groups in Lac or VO2 I. During anastomosis,significant more vasoconstrictors were required to maintain perfusion pressure in Group T. Conclusion SVV and LVETc both can adjust the goal-directed fluid therapy to prevent the occurrence of cardiac adverse events during off-pump coronary artery bypass surgery. However,taking LVETc as the goal of capacity management can reduce the total volume of transfusion,maintain the perfusion target and reduce interstitial fluid load. It is beneficial for quicker recoveries of organs and intestinal function,and rapid rehabilitation.

关 键 词：不停跳冠脉搭桥术 每搏量变异度 校正左室射血时间 目标导向容量管理 

分 类 号：R614[医药卫生—麻醉学]