脉波指示连续心排量监测技术在老年患者不停跳冠状动脉旁路移植术中血流动力学监测的应用

郎利; 傅润乔; 张凤英

doi:10.3969/j.issn.2095-5227.2013.08.018

脉波指示连续心排量监测技术在老年患者不停跳冠状动脉旁路移植术中血流动力学监测的应用

Application of pulse-indicated continuous cardiac output measurement system in monitoring hemodynamics of elderly heart disease patients during off-pump coronary artery bypass grafting

摘要

摘要: 目的通过脉波指示连续心排量监测(pulse-indicated continuous cardiac output，PiCCO)监测老年患者不停跳(off-pump)冠状动脉旁路移植(coronary artery bypass grafting，CABG)术中血流动力学变化。方法经筛选的本院老年冠状动脉硬化性心脏病30例在不停跳下行冠状动脉旁路移植术。应用PiCCO监测动脉压(ABP)、心率(HR)、中心静脉压(CVP)、心输出量指数(CO)、心脏指数(CI)、全心射血分数(GEF)、每搏量指数(SVI)、胸腔内血容量指数(ITBI)、全心舒张末期容量指数(GEDVI)等指标。分别记录手术前(T₀)、乳内动脉(LIMA)-前降支(LAD)吻合后(T₁)、全部血管吻合后(T₂)、术后2 h(T₃)、术后24 h(T₄)的数据。结果 30例均顺利实施手术。T₀时ABP、CVP、CO、GEF和SVI较T₃、T₄时明显降低(P＜ 0.05)，T₀时ABP、CO、GEF和SVI较T₁时明显降低(P＜ 0.05)，T₀时ITBI和GEDVI较T₃、T₄时降低，T₀时CI较T₃、T₄时明显上升(P＜ 0.05)。30例均恢复顺利，无外科并发症及与PiCCO操作相关的并发症。结论 PiCCO技术简捷可靠，适合于老年患者CABG的临床应用。

Abstract: Objective To monitor the hemodynamics in elderly heart disease patients during off-pump coronary artery bypass grafting (CABG) with pulse-indicated continuous cardiac output (PiCCO) system. Methods Thirty elderly patients with coronary ateroclerotic heart disease who underwent off-pump CABG were included in this study. Their ABP, HR, CVP, CO, CI, GEF, SVI, ITBI and GEDVI were measured with PiCCO system at T₀, T₁, T₂, T₃ and T₄ , respectively. Results The operation was successful for all the patients. The ABP, CVP, CO, GEF and SVI were significantly lower at T₀ than at T₃ and T₄ , and at T₀ than at T₁ (P＜ 0.05).The ITBI and GEDVI were significantly lower while the CI was significantly higher at T₃ and T₄ than at T₀ (P＜ 0.05). The patients recovered with no surgical and PiCCO manipulation-related complications. Conclusion PiCCO system is a simple and reliable device for monitoring hemodynamics in elderly coronary disease patients during off-pump CABG．

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