不停跳冠状动脉旁路移植术中应用MostCare/PRAM监测系统进行血流动力学监测的临床研究  

Clinical research on the perioperative hemodynamic changes recorded by MostCare/PRAM system in the off-pump coronary artery bypass grafting surgery

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,P.R.China;Department of Cardiac Surgery,Tianjin Teda International Cardiovascular Hospital,Tianjin,300000,P.R.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：《中国胸心血管外科临床杂志》2021年第1期104-109,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探究Most Care/PRAM系统监测下不停跳冠状动脉旁路移植术(OPCABG)患者术中血流动力学变化情况和预后分析。方法纳入2016年10月至2017年1月安贞医院89例OPCABG患者,其中男53例、女36例,年龄(60.50±8.40)岁。记录术中血流动力学变化情况。按是否发生心肌梗死、低心排血量等严重循环不良事件,分为平稳组和严重循环不良事件组,进行相关分析。结果手术全程监测完整血流动力学数据患者65例,开胸前和关胸后被动抬高试验的每搏量(SV)升高均值分别为23.00%±3.20%和29.40%±3.70%。麻醉、开胸、应用肝素时、搭桥中、应用鱼精蛋白时、关胸和术毕7个时间段,SV明显下降,外周血管阻力指数(SVRI)持续显著增加,最大压力梯度(d P/d T)和心脏循环效率(CCE)在麻醉后明显下降,搭桥时下降到最低,其后逐渐升高;每搏量变异率(SVV)和脉压变异率(PPV)在麻醉后下降,开胸后一直升高。89例患者发生严重循环不良事件共9例,其中4例死亡。严重循环不良事件组术中基础SVRI、SVV和PPV均显著高于平稳组(P<0.05),CCE、d P/d T和SV差异无统计学意义(P>0.05)。术中基础SVRI、CCE、d P/d T、SVV、PPV和SV均值与预后指标均无明显相关性。结论OPCABG术中易出现血流动力学的改变,因此,OPCABG术中宜应用Most Care/PRAM仪进行血流动力学监测,并及时纠正血流动力学异常。Objective To investigate the perioperative hemodynamic changes of off-pump coronary artery bypass grafting(OPCABG)patients monitored by pulse recorded analysis method(Most Care/PRAM devices)and its relationship with the prognosis.Methods A total of 89 patients who underwent OPCABG from October 2016 to January2017 in Beiijng Anzhen Hospital were included,including 53 males and 36 females aged 60.50±8.40 years.The hemodynamic changes were recorded.The patients were divided into two groups(a major adverse cardiovascular events group and a stable group)according to whether major adverse cardiovascular events occurred or not.The difference of hemodynamic changes between the two groups was analysed.Results The mean percentage increases of stroke volume(SV)in the passive leg raising(PLR)test before opening chest and after chest closure were 23.00%±3.20%and29.40%±3.70%,respectively.Hemodynamic data were analysed seven times,namely,anaesthesia,opening chest,heparin administration,coronary artery bypass grafting,protamine administration,thoracic closure and after operation.SV was significantly decreased during above periods,while systemic vascular resistance index(SVRI)was significantly increased.Cardiac circle efficiency(CCE)and maximum pressure gradient(dP/dT)were decreased after anaesthesia,and decreased to the lowest value during the procedure of bypass grafting,and then they began to increase gradually after the manipulation of bypass grafting was finished.Stroke volume variation(SVV)and pulse pressure variation(PPV)were slightly decreased during anaesthesia,then increased significantly through the whole surgery.Major adverse cardiovascular events occurred in 9 patients and 4 of them died.The basic mean values of SVRI,SVV and PPV of patients in the major adverse cardiovascular events group before opening chest were significantly higher than those of patients in the stable group.There was no significant difference in the mean values of CCE,dP/dT or SV between the two groups.There was no significant correlation betwe

关 键 词：不停跳冠状动脉旁路移植术 压力记录分析法 双下肢被动抬高试验 心脏循环功效 最大压力梯度 

分 类 号：R654.2[医药卫生—外科学]