门静脉高压患儿围术期血流动力学的变化  

Characteristics of perioperative systemic hemodynamic alternations in children with portal hypertension

作　　者：韩丁[1] 魏国[1] 欧阳川[2] 陈刚[1] 张弦[1] 刘宏妍[1] 马旭波[1] 潘守东[1] HAN Ding;WEI Guo;OUYANG Chuan;CHEN Gang;ZHANG Xian;UU Hongyan;MA Xubo;PAN Shoudong(Department of Anesthesia,Capital Institute of Pediatrics Affiliated Children's Hospital,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院麻醉科,100020 [2]首都医科大学附属北京安贞医院麻醉科

出　　处：《临床麻醉学杂志》2019年第8期755-758,共4页Journal of Clinical Anesthesiology

基　　金：首都临床特色应用研究基金资助项目(Z181100001718096)

摘　　要：目的通过压力记录分析法(PRAM)分析门静脉高压(PH)患儿围术期动脉后负荷、心功能、容量负荷参数的一般变化特点,为临床医师提供参考。方法纳入2017年1-12月本院择期行肠-门静脉(改良)分流手术的PH患儿共20例(PH组),年龄<14岁,ASAⅡ或Ⅲ级。随机选取同期年龄匹配行开腹手术患儿20例作为对照组(非PH组)。在麻醉诱导后,常规行桡动脉置管以监测血压和使用PRAM。在切皮前(T1)、切皮5 min后(T2)、关腹(T3)、术毕时(T4)使用PRAM记录SBP、DBP、HR、重脉压、每搏量指数(SVI)、心脏指数(CI)、心室弹性(Ees)、动脉后负荷(Ea)、脉压变异度(PPV);记录麻醉时间、麻醉药物用量。结果与非PH组比较,T1-T4时PH组HR明显减慢(P<0.05),T3-T4时重脉压明显增高(P<0.05),T1、T2、T4时SVI明显增高(P<0.05),T1、T2、T4时Ea明显降低(P<0.05),T2、T3时PPV明显降低(P<0.05),T3、T4时Ees明显降低(P<0.05)。两组间SBP、DBP与CI差异无统计学意义。结论PH患儿围术期血流动力学变化特点为每搏量增高和动脉后负荷降低,心功能轻微受损,脉压变异度数值偏低。Objective To analyze the perioperative change in cardiac function,arterial afterload,and volume load parameters using pressure recording analytical method(PRAM)in children with portal hypertension(PH),serving as references for clinicians.Methods From January to December 2017,20 children with PH scheduled to receive Rex(modified)shunt surgery(group PH)in Capital Institute of Pediatrics Affiliated Children’s Hospital were enrolled,aged<14 years,ASA physical statusⅡorⅢ.Group matched contemporary 20 children of the similar age undergoing laparotomy were selected as controls(group non-PH).After anesthesia induction,radial catheterization was routinely administered to monitor arterial pressures and use PRAM.Systolic arterial pressure,diastolic arterial pressure,dicrotic pressure,heart rate,stroke volume index(SVI),cardiac index(CI),ventricular elastance(Ees),arterial afterload(Ea),and pulse pressure variation(PPV)were recorded by PRAM at before surgical incision(T1),5 min after surgical incision(T2),abdominal closure(T3),and end of the surgery(T4).Anesthesia duration and dosage of anesthetics were recorded.Results Compared with group non-PH,group PH had significantly decreased heart rate at T1-T4(P<0.05),significantly increased dicrotic pressure at T3 and T4(P<0.05),significantly increased SVI at T1,T2 and T4(P<0.05),significantly decreased Ea at T1,T2 and T4(P<0.05),significantly decreased PPV at T2 and T3(P<0.05),and significantly decreased Ees at T3 and T4(P<0.05).Systolic arterial pressure,diastolic arterial pressure,and CI were not significantly different between groups.Conclusion Hemodynamics of children with PH is characterized by increased stroke volume,decreased arterial afterload,mildly deteriorated cardiac function,and decreased pulse pressure variation.

关 键 词：门静脉高压 体循环 血流动力学 患儿 

分 类 号：R54[医药卫生—心血管疾病]