中华生物医学工程杂志
中華生物醫學工程雜誌
중화생물의학공정잡지
CHINESE JOURNAL OF BIOMEDICAL ENGINEERING
2011年
6期
496-500
,共5页
李向宇%柳垂亮%潘飞鹏%黎涌%招伟贤
李嚮宇%柳垂亮%潘飛鵬%黎湧%招偉賢
리향우%류수량%반비붕%려용%초위현
冠状动脉旁路移植术%血液动力学%参附注射液%代谢
冠狀動脈徬路移植術%血液動力學%參附註射液%代謝
관상동맥방로이식술%혈액동역학%삼부주사액%대사
Off pump coronary artery bypass graft%Shenfu injection%Hemodynamics%Oxygen metabolism
目的 观测非体外循环冠脉搭桥术(OPCABG)中参附注射液对血流动力学和全身氧代谢的影响.方法 选择本院冠心病择期行OPCABG手术患者56例,美国麻醉医师协会(ASA)Ⅱ～Ⅲ级,完全随机分为参附组(SF组,29例)和生理盐水对照组(NS组,27例).SF组在手术切皮前和吻合心脏血管前各静脉注射参附注射液40 ml,NS组则分别注射等量生理盐水.用漂浮导管和动脉、混合静脉血气分析监测麻醉手术过程中麻醉诱导完成并血流动力学稳定时(T1)、锯胸骨后(T2),吻合血管前(T3),吻合前降支时(T4),吻合后降支或右冠状动脉时(T5),吻合左回旋支或对角支时(T6),血管吻合完成后心脏恢复原位置(T7),闭合胸骨前(T8)及手术结束时(T9)9个时点的血流动力学和全身氧代谢.结果 在T5和T6时点,两组的心脏指数(CI)和每搏指数(SI)均明显低于T1时点[(2.1±0.6)和(2.0±0.5)比(2.3±0.5)L·min-1· m-2,(1.7±0.6)和(1.8±0.6)比(2.1±0.5)L·min-1·m-2；(24±10)和(23±8)比(32±7)ml·beat-1· m-2,(22±9)和(22±8)比(32±9) ml·beat-1·m-2,P＜0.05],其中T2和T5时点,SF组的CI略高于NS组[(2.5±0.7)比(2.1±0.6)L·min-1 ·m-2,(2.1±0.6)比(1.7 ±0.6) L·min-1 ·m-2,P＜0.05].整个麻醉手术期间,SF组的心率(HR)、平均动脉压(MAP)、左室工作指数(LVWI)和右室工作指数(RVWI)均略高于NS组(P＜0.05).两组的pH在手术开始后均呈降低变化,其中SF组术毕的pH明显低于NS组(P＜0.05).手术期间两组的碳酸氢根离子(HCO3-)、剩余碱(BE-E)和总二氧化碳(TCO2)均下降,两组间在多个时间点差异有统计学意义(P＜0.05).SF组在麻醉后时点的氧供(DO2)高于NS组,但术中两组间氧耗(vO2)、氧摄取率(O2ext)和体温(T)的变化差异无统计学意义(P＜0.05).结论 ASAⅡ～Ⅲ级患者非体外循环冠脉搭桥术中,在循环功能和氧供-氧耗相对稳定条件下静脉给予参附注射液,未见对血流动力学和氧代谢参数产生显著影响.
目的 觀測非體外循環冠脈搭橋術(OPCABG)中參附註射液對血流動力學和全身氧代謝的影響.方法 選擇本院冠心病擇期行OPCABG手術患者56例,美國痳醉醫師協會(ASA)Ⅱ～Ⅲ級,完全隨機分為參附組(SF組,29例)和生理鹽水對照組(NS組,27例).SF組在手術切皮前和吻閤心髒血管前各靜脈註射參附註射液40 ml,NS組則分彆註射等量生理鹽水.用漂浮導管和動脈、混閤靜脈血氣分析鑑測痳醉手術過程中痳醉誘導完成併血流動力學穩定時(T1)、鋸胸骨後(T2),吻閤血管前(T3),吻閤前降支時(T4),吻閤後降支或右冠狀動脈時(T5),吻閤左迴鏇支或對角支時(T6),血管吻閤完成後心髒恢複原位置(T7),閉閤胸骨前(T8)及手術結束時(T9)9箇時點的血流動力學和全身氧代謝.結果 在T5和T6時點,兩組的心髒指數(CI)和每搏指數(SI)均明顯低于T1時點[(2.1±0.6)和(2.0±0.5)比(2.3±0.5)L·min-1· m-2,(1.7±0.6)和(1.8±0.6)比(2.1±0.5)L·min-1·m-2；(24±10)和(23±8)比(32±7)ml·beat-1· m-2,(22±9)和(22±8)比(32±9) ml·beat-1·m-2,P＜0.05],其中T2和T5時點,SF組的CI略高于NS組[(2.5±0.7)比(2.1±0.6)L·min-1 ·m-2,(2.1±0.6)比(1.7 ±0.6) L·min-1 ·m-2,P＜0.05].整箇痳醉手術期間,SF組的心率(HR)、平均動脈壓(MAP)、左室工作指數(LVWI)和右室工作指數(RVWI)均略高于NS組(P＜0.05).兩組的pH在手術開始後均呈降低變化,其中SF組術畢的pH明顯低于NS組(P＜0.05).手術期間兩組的碳痠氫根離子(HCO3-)、剩餘堿(BE-E)和總二氧化碳(TCO2)均下降,兩組間在多箇時間點差異有統計學意義(P＜0.05).SF組在痳醉後時點的氧供(DO2)高于NS組,但術中兩組間氧耗(vO2)、氧攝取率(O2ext)和體溫(T)的變化差異無統計學意義(P＜0.05).結論 ASAⅡ～Ⅲ級患者非體外循環冠脈搭橋術中,在循環功能和氧供-氧耗相對穩定條件下靜脈給予參附註射液,未見對血流動力學和氧代謝參數產生顯著影響.
목적 관측비체외순배관맥탑교술(OPCABG)중삼부주사액대혈류동역학화전신양대사적영향.방법 선택본원관심병택기행OPCABG수술환자56례,미국마취의사협회(ASA)Ⅱ～Ⅲ급,완전수궤분위삼부조(SF조,29례)화생리염수대조조(NS조,27례).SF조재수술절피전화문합심장혈관전각정맥주사삼부주사액40 ml,NS조칙분별주사등량생리염수.용표부도관화동맥、혼합정맥혈기분석감측마취수술과정중마취유도완성병혈류동역학은정시(T1)、거흉골후(T2),문합혈관전(T3),문합전강지시(T4),문합후강지혹우관상동맥시(T5),문합좌회선지혹대각지시(T6),혈관문합완성후심장회복원위치(T7),폐합흉골전(T8)급수술결속시(T9)9개시점적혈류동역학화전신양대사.결과 재T5화T6시점,량조적심장지수(CI)화매박지수(SI)균명현저우T1시점[(2.1±0.6)화(2.0±0.5)비(2.3±0.5)L·min-1· m-2,(1.7±0.6)화(1.8±0.6)비(2.1±0.5)L·min-1·m-2；(24±10)화(23±8)비(32±7)ml·beat-1· m-2,(22±9)화(22±8)비(32±9) ml·beat-1·m-2,P＜0.05],기중T2화T5시점,SF조적CI략고우NS조[(2.5±0.7)비(2.1±0.6)L·min-1 ·m-2,(2.1±0.6)비(1.7 ±0.6) L·min-1 ·m-2,P＜0.05].정개마취수술기간,SF조적심솔(HR)、평균동맥압(MAP)、좌실공작지수(LVWI)화우실공작지수(RVWI)균략고우NS조(P＜0.05).량조적pH재수술개시후균정강저변화,기중SF조술필적pH명현저우NS조(P＜0.05).수술기간량조적탄산경근리자(HCO3-)、잉여감(BE-E)화총이양화탄(TCO2)균하강,량조간재다개시간점차이유통계학의의(P＜0.05).SF조재마취후시점적양공(DO2)고우NS조,단술중량조간양모(vO2)、양섭취솔(O2ext)화체온(T)적변화차이무통계학의의(P＜0.05).결론 ASAⅡ～Ⅲ급환자비체외순배관맥탑교술중,재순배공능화양공-양모상대은정조건하정맥급여삼부주사액,미견대혈류동역학화양대사삼수산생현저영향.
Objective To investigate the effect of Shenfu injection on hemodynamics and systemic oxygen metabolism during off-pump coronary artery bypass grafting (OPCABG).Methods Fifty-six patients with coronary heart disease undergoing selective OPCABG (ASA Ⅱ -Ⅲ )were randomly assigned to Shenfu group (SF,n=29) and normal saline control group (NS,n=27).Patients in SF group received Shenfu 40 ml via intravenous injection prior to dermal preparation and graft anastamosis,respectively.In contrast,an equivalent volume of normal saline was injected in subjects of NS group.Hemodynamics and systemic oxygen metabolism was monitored using Swan-Ganz catheter,arterial and mixed venous blood gas analysis during anesthesia and surgery at nine time points of post anesthetic induction with stable hemodynamics (T1),after stemotomy (T2),before vascular anastomosis (T3),anterior drop branch anastomosis (T4),posterior descending artery or right coronary artery anastamosis(T5),left circumflex coronary artery or diagonal branch anastamosis (T6),cardiac at original position after vascular anastomosis (T7),before sternum closur(T8)and the end of operation(T9).Results Cardiac index (CI) and stroke index (SI) were significantly lower after posterior descending artery or right coronary artery anastamosis (T5) and left circumflex coronary artery or diagonal branch anastamosis (T6) as compared with post anesthetic induction with stable hemodynamics (T1)[(2.1 ±0.6) and (2.0 ±0.5) vs (2.3±0.5) L·min-1·m-2,(1.7 ±0.6) and (1.8 ±0.6) vs (2.1±0.5) L·min-1·m-2;(24±10) and (23 ±8) vs (32±7) ml·beat-1·m-2,(22 ±9) and (22 ±8) vs (32±9) ml·beat-1·m-2,P＜0.05].As compared with NS group,CI in SF group after sternotomy (T2) or T5 was slightly higher[ (2.5 ±0.7) vs (2.1 ±0.6) L·min-1·m-2,(2.1 ±0.6) vs (1.7 ±0.6) L·min-1·m-2,P＜0.05].During the operation,HR,MAP,LVWI and RVWI in SF group were slightly higher as compared with NS group (P＜0.05).pH decreased with time in both groups and was markedly lower in SF group compared with NS group (P＜0.05).During the operation,HCO3-,BE-E and TCO2 declined in both groups and had significant statistical difference (P＜0.05) at multiple time points.Oxygen delivery (DO2) was higher in SF group compared with NS group.No significant difference (P＞0.05) was found in VO2,O2ext and T during the operation in both groups.Conclusion During OPCABG in subjects with grade Ⅱ -Ⅲ ASA,intravenous Shenfu injection does not confer significant impact on hemodynamic and oxygen metabolism parameters with stable circulatory function and oxygen supply/consumption.
