CI目标导向循环管理对肝移植术婴幼儿的心肌保护效应:动脉压力波形分析法监测  

Myocardial protective effect of goal-directed circulation management guided by CI in infants undergoing liver transplantation:monitoring using pressure recording analytical method

作　　者：窦晓婧[1] 王清平[1] 翁亦齐[1] 刘伟华[1] 喻文立[1] Dou Xiaojing;Wang Qingping;Weng Yiqi;Liu Weihua;Yu Wenli(Department of Anesthesiology,The First Center Hospital of Tianjin,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院麻醉科,300192

出　　处：《中华麻醉学杂志》2021年第6期656-661,共6页Chinese Journal of Anesthesiology

基　　金：2018天津市自然科学基金面上项目(18JCYBJC27500);天津市临床重点学科(麻醉学)建设项目。

摘　　要：目的:评价以动脉压力波形分析法(PRAM)监测的CI为目标导向的循环管理对肝移植术婴幼儿的心肌保护效应。方法:选取亲体肝移植术患儿(均诊断为先天性胆道闭锁)120例,年龄5~15个月,体重5.5~10.0 kg,采用随机数字表法分为2组(n=60):常规组(R组)及CI目标导向管理组(CI-G组)。R组根据CVP、连续有创动脉压、血气分析等监测指导术中循环管理,CI-G组术中通过桡动脉连接PRAM/Mostcare进行血流动力学监测,以CI为目标导向进行循环管理。记录液体入量、血流动力学指标HR、MAP、CVP的最高值及最低值,以及再灌注5 min内各指标的最大波动值(△_(R)HR、△_(R)MAP、△_(R)CVP)以及再灌注综合征的发生情况。于麻醉开始(T_(0))、再灌注前5 min(T_(1))、新肝期30 min(T_(2))、新肝期3 h(T_(3))和术后12 h(T_(4))时检测血清cTnI、N末端血浆脑利钠肽前体(NT-pro-BNP)、IL-6、TNF-α和高迁移率族蛋白B1(HMGB1)的浓度。记录术后机械通气时间、ICU停留时间、ICU期间心功能不全和肺感染发生情况以及住院时间。结果:与R组比较,CI-G组液体入量、最高CVP、△_(R)HR、△_(R)MAP、再灌注综合征发生率降低,最低MAP升高,T_(2)~T_(4)时血清cTnI、NT-pro-BNP、IL-6、TNF-α和HMGB1浓度降低,术后机械通气时间和ICU停留时间缩短,ICU期间心功能不全发生率降低(P<0.05)。结论:婴幼儿亲体肝移植术中,以PRAM监测的CI为目标导向的循环管理可精准指导液体及血管活性药物使用,稳定循环功能,可产生一定心肌保护效应。Objective To evaluate the myocardial protective effect of goal-directed circulation management guided by cardiac index(CI)monitored by pressure recording analytical method(PRAM)in infants undergoing pediatric liver transplantation.Methods A total of 120 pediatric patients,aged 5-15 months,weighing 5.5-10.0 kg,scheduled for elective living donor liver transplantation(all diagnosed with congenital biliary atresia)were selected and divided into 2 groups(n=60 each)using a random number table method:routine group(group R)and goal-directed management guided by CI group(group CI-G).Patients in group R received routine hemodynamic monitoring according to central venous pressure(CVP),continuous invasive arterial pressure,blood gas analysis and other monitoring methods to guide intraoperative circulation management.Patients in CI-G group received intraoperative hemodynamic monitoring through radial artery using PRAM/Mostcare,and related treatments were guided by PRAM hemodynamic monitoring indicators.The intraoperative volume of fluid intake,highest and lowest values of parameters of hemodynamics such as heart rate(HR),mean arterial pressure(MAP)and CVP,the maximum fluctuations(△RHR,△RMAP and△RCVP)and the development of reperfusion syndrome within 5 min of reperfusion were recorded.At the beginning of anesthesia(T_(0)),at 5 min before reperfusion(T_(1)),at 30 min of neohepatic phase(T_(2)),at 3 h of neohepatic phase(T_(3))and at 12 h after operation(T_(4)),concentrations of serum cardiac troponin I(cTnI),N-terminal plasma brain natriuretic peptide precursor(NT-pro-BNP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and high mobility group protein B1(HMGB1)were determined.Mechanical ventilation time,duration of intensive care unit(ICU)stay,the development of heart failure and pulmonary infection,length of hospital stay were recorded.Results Compared with group R,the intraoperative volume of fluid intake,highest value of CVP,△RHR,△RMAP and the incidence of reperfusion syndrome were significantly decreased,lowe

关 键 词：心排血量 监测 生理学 儿童 肝移植 心肌损伤 

分 类 号：R726.1[医药卫生—儿科]