CAJ | 학술논문

目的：研究PRAM技术在体外循环手术中的应用。方法先心病患者20例在心肺转流（CPB）下行先心病根治术。应用MOSTCARE监护仪(核心技术为Pressure Recording Analytical Method，PRAM)分别记录平均动脉压（MAP）、心率（HR）、心输出量（CO）、心脏指数（CI）、周围血管阻力（SVR）、外周血管阻力指数（SVRI）、心搏量（SV）、心搏量指数（SVI）、心搏量变异度（SVV）、心脏循环效率（CCE）、最大压力梯度（dp/dt）。记录时间点为麻醉诱导前（T1）、麻醉诱导后至气管插管前（T2）、停跳后（T3）、体外循环结束后30 min（T4）、手术后6 h（T5）。结果 T2时MAP、CCE、dp/dt值低于T1时（P＜0.05）；T3时MAP、HR、CO、CI、SV、SVI、SVV、CCE、dp/dt低于T1和T4时（P＜0.05）；T4时CI、SVI高于T1时（P＜0.05）；T5时MAP、CCE、dp/dt、SVRI值低于T1时（P＜0.05）；T5时MAP、CI、CCE、dp/dt、SVV、SVI值低于T4时（P＜0.05）。结论 PRAM技术是微创科学，通过此项技术可准确测定患者血流动力学的变化，并指导血管活性药物的使用和扩容治疗，适合于体外循环手术患者的围术期监测。
목적：연구PRAM기술재체외순배수술중적응용。방법선심병환자20례재심폐전류（CPB）하행선심병근치술。응용MOSTCARE감호의(핵심기술위Pressure Recording Analytical Method，PRAM)분별기록평균동맥압（MAP）、심솔（HR）、심수출량（CO）、심장지수（CI）、주위혈관조력（SVR）、외주혈관조력지수（SVRI）、심박량（SV）、심박량지수（SVI）、심박량변이도（SVV）、심장순배효솔（CCE）、최대압력제도（dp/dt）。기록시간점위마취유도전（T1）、마취유도후지기관삽관전（T2）、정도후（T3）、체외순배결속후30 min（T4）、수술후6 h（T5）。결과 T2시MAP、CCE、dp/dt치저우T1시（P＜0.05）；T3시MAP、HR、CO、CI、SV、SVI、SVV、CCE、dp/dt저우T1화T4시（P＜0.05）；T4시CI、SVI고우T1시（P＜0.05）；T5시MAP、CCE、dp/dt、SVRI치저우T1시（P＜0.05）；T5시MAP、CI、CCE、dp/dt、SVV、SVI치저우T4시（P＜0.05）。결론 PRAM기술시미창과학，통과차항기술가준학측정환자혈류동역학적변화，병지도혈관활성약물적사용화확용치료，괄합우체외순배수술환자적위술기감측。
Objective To study the PRAM technology in the application of cardiopulmonary bypass surgery. Methods 20 patients with congenital heart disease accepted heart radical prostatectomy in cardiopulmonary flow were investigated in this study. Mean arterial pressure, Heart Rate, Cardiac Output, Cardiac Index, Systemic vascular Resistance, Systemic vascular Resistance Index, Stroke Volume, Stroke Volume Index, Cardiac Cycle Efficience, Maximum Pressure Gradient, Stroke Volume Variation are recorded by MOSTCARE monitor in different times. The first time(T1) Is before anesthesia induction;the second time(T2) is after anesthesia induction;the third time(T3) is after cardiac arrest; the fourth time(T4) is after the end of extracorporeal circulation for 30 minutes;the fifth time(T5) is after the surgery for 6 hours. The numerus of MAP, CCE, dp/dt were lower at T2 than T1(P<0.05);the numerus of MAP, HR, CO, CI, SV, SVI, SVV, CCE, dp/dt were lower at T3 than T1 and T4;the numerus of CI、SVI were higher at T4 than T1;The numerus of MAP, CCE, dp/dt, SVRI were lower at T5 than T1;The numerus of MAP, CI, CCE, dp/dt, SVV, SVI were lower at T5 than T1. Results The PRAM technology is minimally invasive and scientific. The hemodynamic changes of the patients can be determined accurately by the PRAM technology. The PRAM technology can guide the use of vasoactive drugs and expansion of treatment. It is suitable for cardiopulmonary bypass surgy in patients with perioperative monitoring.