PRAM/Mostcare仪监测下心脏不停跳冠状动脉旁路移植术中血流动力学变化  

Hemodynamic changes during off-pump coronary artery bypass grafting under the monitoring of PRAM/Mostcare device

作　　者：邹以席[1] 刘金松 陈滵 黄方炯[1] 杨秀滨 ZOU Yixi;LIU Jinsong;CHEN Mi;HUANG Fangjiong;YANG Xiubin(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Cardiac Surgery,Tianjin Teda international cardiovascular Hospital,Tianjin 300000,China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,北京100029 [2]天津市泰达国际心血管病医院心脏外科,天津300000

出　　处：《中华实用诊断与治疗杂志》2020年第9期913-916,共4页Journal of Chinese Practical Diagnosis and Therapy

摘　　要：目的探讨PRAM/Mostcare监测下行不停跳冠状动脉旁路移植术(off-pump coronary artery bypass grafting, OPCABG)患者术中血流动力学变化情况。方法 65例行OPCABG患者,应用MostCare/PRAM仪监测术中每博输出量、外周血管阻力、心脏循环效率、最大压力梯度、每博输出量变异率和脉压变异率。比较桥血管远端吻合(乳内动脉吻合到前降支、大隐静脉吻合到左回旋支和/或右冠状动脉)前、中、后的血流动力学指标变化;比较OPCABG术前、后的血流动力学指标变化。将62例需调整头低位维持循环等生命体征平稳者分为头低15°~30°组34例和头低>30°~45°组28例,比较2组患者后降支和左回旋支远端吻合前、后血流动力学指标的变化。结果每博输出量变异率、脉压变异率在桥血管远端吻合中高于吻合前和吻合后(P<0.05),吻合后高于吻合前(P<0.05);每博输出量、心脏循环效率、最大压力梯度在吻合中低于吻合前和吻合后(P<0.05),吻合后低于吻合前(P<0.05);外周血管阻力在吻合中低于吻合前和吻合后(P<0.05),吻合后高于吻合前(P<0.05)。术后脉压变异率[(16.00±10.00)%]、每博输出量变异率[(11.90±6.80)%]和外周血管阻力指数(2 629.00±629.00)均高于术前[(13.00±10.00)%、(11.50±7.60)%、2 464.00±423.00],每博输出量[(60.00±20.00) mL]、心脏循环效率[-0.1(-0.58,0.14)u]和最大压力梯度[(0.71±0.27)mm Hg/s]均低于术前[(69.00±18.00) mL、0.11(-0.15,0.28)u、(0.79±0.24)mm Hg/s](P<0.05)。头低15°~30°组后降支及左回旋支吻合前、后每博输出量、心脏循环效率、最大压力梯度、脉压变异率、每博输出量变异率和外周血管阻力与头低>30°~45°组比较差异均无统计学意义(P>0.05);头低>30°~45°组患者术中应用主动脉球囊反搏救治4例,其中2例应用主动脉球囊反搏加体外膜肺氧合救治;头低15°~30°组术中顺利。结论 OPCABG术中可出现心肌收缩力和心排量下降、容量Objective To investigate the hemodynamic changes during off-pump coronary artery bypass grafting(OPCABG) under the monitoring of PRAM/Mostcare devices. Methods Sixty-five patients undergoing OPCABG under the monitoring of PRAM/Mostcare were detected the hemodynamic indexes during operation, including stroke volume, systemic vascular resistance index(SVRI), cardiac circle efficiency, maximum pressure gradient(dP/dT), stroke volume variation(SVV) and pulse pressure variation(PPV). The hemodynamic changes were compared before, during and after graft anastomosis(left internal mammary artery to left anterior descending artery, great saphenous vein to left circumflex and/or right coronary artery), as well as before and after OPCABG. In 65 patients, 62 patients were adjusted their head down to maintain hemodynamic stableness, and were divided into head down 15° to 30° group(n=34) and >30° to 45° group(n=28). The hemodynamic changes were compared before and after left anterior descending artery and left circumflex distal anastomosis in two groups. Results SVV and PPV were higher during graft anastomosis than those before and after anastomosis(P<0.05), and higher after anastomosis than those before anastomosis(P<0.05). Stroke volume, cardiac circle efficiency and dP/dT were lower during graft anastomosis than those before and after anastomosis(P<0.05), and lower after anastomosis than those before anastomosis(P<0.05). SVRI was lower during graft anastomosis than that before and after anastomosis(P<0.05), and lower before anastomosis than that after anastomosis(P<0.05). The SVV, PPV and SVRI were higher after anastomosis((16.00±10.00)%,(11.90±6.80)%,2 629.00±629.00)than those before anastomosis((13.00±10.00)%,(11.50±7.60)%,2 464.00±423.00),whereas stroke volume,cardiac cicle efficiency and dP/dT were lower after anastomosis((60.00±20.00)mL,-0.1(-0.58,0.14)u,(0.71±0.27)mm Hg/s)than those before anastomosis((69.00±18.00)mL,0.1(-0.15,0.28)u,(0.79±0.24)mm Hg/s)(P<0.05).All the above indexes showed no significant

关 键 词：不停跳冠状动脉旁路移植术 PRAM/Mostcare监测 血流动力学 心脏循环效率 最大压力梯度 头低位 

分 类 号：R654.2[医药卫生—外科学]