婴儿室间隔缺损修补术中血流动力学变化的研究  

Hemodynamic changes in infants undergoing ventricular septal defect repair surgery

作　　者：张冬妮 马骏[1] 欧阳川[1] 谢思远 ZHANG Dongni;MA Jun;OUYANG Chuan;XIE Siyuan(Department of Anesthesiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所麻醉中心,100029 [2]首都儿科研究所附属儿童医院麻醉科

出　　处：《心肺血管病杂志》2020年第1期58-61,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市医院管理局临床医学发展专项经费(ZYLX201810)。

摘　　要：目的:使用压力记录分析法(PRAM)研究不同月龄室间隔缺损(VSD)修补术,麻醉中血流动力学的变化规律。方法:本研究纳入≤1岁VSD共339例,分为小月龄组(L组,月龄<6个月)和大月龄组(H组,月龄≥6个月)。入室全身麻醉、气管插管、桡动脉穿刺置管后,使用Mostcare监测仪在切皮前(T1)、开心包(T2)、停机时(T3)、拔除主动脉插管后(T4)和术毕离室前(T5)监测心率(HR)、收缩压(Sys P)、舒张压(Dia P)、重脉压(Dic P)、心脏指数(CI)、每搏量指数(SVI)、心动周期效率(CCE)、脉压变异度(PPV)、压力升支最大斜率(dp/dtmax)、体循环阻力指数(SVRI),计算相应时间点正性肌力药物评分(IS)。结果:全组各点比较,CCE、CI、SVI在T3显著低于术中其他各点(P<0.05),PPV、SVRI在T3显著高于其他各点(P<0.01)。L组CCE在T4、T5显著低于H组(P<0.05),L组CI在T3、T4、T5显著高于H组(P<0.01),L组PPV、SVI在T4、T5显著高于H组(P<0.01),L组IS在T1、T2、T3、T4、T5显著高于H组(P<0.05)。结论:339例婴儿VSD修补术中,PRAM法监测血流动力学,全组在停机时最为低下,改良超滤后明显改善。大婴儿组更积极的扩容治疗,是循环能量效应改善更明显的主要原因。Objective:To evaluate the hemodynamic changes of infants undergoing ventricular septal defect repair surgery in different age groups by using pressure recording analysis method(PRAM).Methods:339 infants with ventricular septal defect of≤1-year-old were enrolled in this study.They were divided into small-month-old group(group L,<6 months)and large-month-age group(group H,≥6 months).Radial artery pressure monitoring was set up after induction of anesthesia and trachea intubation,hemodynamic parameters were monitored with Mostcare.Heart rate,arterial pressure,cardiac index,stroke volume index,cardiac cycle efficiency,pulse pressure variation,dp/dtmax,indexed systemic vascular resistance and inotropic score are recorded before surgical incision(T1),after cut pericardium(T2),separation from cardiopulmonary bypass(CPB)(T3),after removal of aortic cannula(T4),and end of operation(T5).Results:CCE,CI,SVI were significantly lower in T3 than T1,T2,T4 and T5(P<0.05).PPV,SVRI were significantly higher in T3 than T1,T2,T4 and T5(P<0.01).In group L,CCE was significantly lower in T4 and T5 than in group H(P<0.05),and CI was significantly higher in T3,T4 and T5 than in group H(P<0.01).Compared with group H,PPV and SVI in group L were significantly higher in T4 and T5(P<0.05).IS in group L was significantly higher in T1,T2,T3,T4 and T5 than in group H(P<0.05).Conclusions:In 339 infants undergoing VSD repair,hemodynamics monitored by PRAM was the worst at the time of separation from CPB and was significantly improved after modified ultrafiltration.The more positive fluid therapy of the group H is the main reason for the higher cycle energy efficiency.

关 键 词：室间隔缺损 压力记录分析法 心动周期效率 

分 类 号：R54[医药卫生—心血管疾病]