左前降支搭桥对心功能的影响  

Effects of left anterior descending bypass on cardiac function

作　　者：赵亮 李亚楠 ZHAO Liang;LI Ya-nan(Department of Anesthesiology of Central China Fuwai Hospital,Zhengzhou 451464,China)

机构地区：[1]阜外华中心血管病医院,郑州451464

出　　处：《医药论坛杂志》2023年第2期9-12,共4页Journal of Medical Forum

摘　　要：目的 非体外循环下冠状动脉旁路移植术(off-pump coronary artery bypass grafting, OPCABG)术中血流动力学波动较大,围术期管理非常具有挑战性,本研究旨在通过在OPCABG术中使用全容积3D经食道超声(Full-volume 3D transesophageal echocardiography, Full-volume 3D TEE)测量左右心室参数,明确左前降支(left anterior descending artery, LAD)搭桥对心功能的影响。方法 OPCABG手术纳入37个病例,术中使用Full-volume 3D TEE测量左右心室血流动力学变化相关数据。记录时间点分别为:麻醉诱导平稳后切皮前(T1),在心脏前壁左前降支于固定器固定后5 min(T2),收集左右心室血流动力学变化数据。结果 T2中心静脉压(Central venous pressure, CVP)、肺动脉平均压(Mean pulmonary artery pressure, MPAP)、心率(Heart rate, HR)较T1升高且具有统计学意义(P<0.0005);T2左室每搏输出量指数(Left ventricular stroke volume index, LVSVI)较T1降低且具有统计学意义(P<0.005);T2右室舒张末期容积(Right ventricular end-diastolic volume index, RVEDVI)、右室每搏输出量指数(Right ventricular stroke volume index, RVSVI)较T1降低且具有统计学意义(P<0.05)。结论 OPCABG左前降支搭桥过程中,血流动力学变化主要原因是心室舒张功能障碍,SVI下降,导致中心静脉压,肺动脉平均压升高,心率代偿增快以维持平均动脉压稳定。Objective Intraoperative hemodynamic fluctuations in off-pump coronary artery bypass grafting(OPCABG) are challenging to manage perioperatively, and the aim of this study was to clarify the effect of left anterior descending(LAD)bypass on cardiac function and by using Full-volume 3D transesophageal echocardiography(Full-volume 3D TEE) during OPCABG to measure right and left ventricular parameters.Methods Thirty-seven cases were included in the OPCABG procedure, and data related to right and left ventricular hemodynamic changes were measured intraoperatively using Full-volume 3D TEE. The recording time points were: before skin incision after induction of anesthesia(T1), and 5 minutes after fixation of the left anterior descending artery in the anterior wall of the heart in a fixator(T2), and the data on the hemodynamic changes of the right and left ventricles were collected.Results Central venous pressure(CVP), mean pulmonary artery pressure(MPAP), and heart rate(HR) were statistically higher in T2 compared with T1(P<0.0005);Left ventricular stroke volume index(LVSVI) decreased in T2 compared with T1 and was statistically significant(P<0.005);Right ventricular stroke volume index(RVSVI) and Right ventricular end-diastolic volume index(RVEDVI) were decreased in T2 compared with T1 and were statistically significant(P<0.05).Conclusion During OPCABG left anterior descending bypass, the main cause of hemodynamic changes is ventricular diastolic dysfunction and decreased SVI, resulting in increased central venous pressure, mean pulmonary artery pressure, and compensatory increase in heart rate to maintain stable mean artery pressure.

关 键 词：不停跳冠状动脉旁路移植术 3维经食道超声心动图 前降支动脉 心功能 

分 类 号：R654.2[医药卫生—外科学]