解放军医学院学报
解放軍醫學院學報
해방군의학원학보
Academic Journal of Chinese Pla Medical School
2013年
8期
845-847
,共3页
冠状动脉旁路移植术%脉波指示连续心排量监测%血流动力学监测
冠狀動脈徬路移植術%脈波指示連續心排量鑑測%血流動力學鑑測
관상동맥방로이식술%맥파지시련속심배량감측%혈류동역학감측
coronary artery bypass graft%pulse-indicated continuous cardiac output%hemodynamic monitioring
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。
目的通過脈波指示連續心排量鑑測(pulse-indicated continuous cardiac output，PiCCO)鑑測老年患者不停跳(off-pump)冠狀動脈徬路移植(coronary artery bypass grafting，CABG)術中血流動力學變化。方法經篩選的本院老年冠狀動脈硬化性心髒病30例在不停跳下行冠狀動脈徬路移植術。應用PiCCO鑑測動脈壓(ABP)、心率(HR)、中心靜脈壓(CVP)、心輸齣量指數(CO)、心髒指數(CI)、全心射血分數(GEF)、每搏量指數(SVI)、胸腔內血容量指數(ITBI)、全心舒張末期容量指數(GEDVI)等指標。分彆記錄手術前(T0)、乳內動脈(LIMA)-前降支(LAD)吻閤後(T1)、全部血管吻閤後(T2)、術後2 h(T3)、術後24 h (T4)的數據。結果30例均順利實施手術。T0時ABP、CVP、CO、GEF和SVI較T3、T4時明顯降低(P＜0.05)，T0時ABP、CO、GEF和SVI較T1時明顯降低(P＜0.05)，T0時ITBI和GEDVI較T3、T4時降低，T0時CI較T3、T4時明顯上升(P＜0.05)。30例均恢複順利，無外科併髮癥及與PiCCO操作相關的併髮癥。結論 PiCCO技術簡捷可靠，適閤于老年患者CABG的臨床應用。
목적통과맥파지시련속심배량감측(pulse-indicated continuous cardiac output，PiCCO)감측노년환자불정도(off-pump)관상동맥방로이식(coronary artery bypass grafting，CABG)술중혈류동역학변화。방법경사선적본원노년관상동맥경화성심장병30례재불정도하행관상동맥방로이식술。응용PiCCO감측동맥압(ABP)、심솔(HR)、중심정맥압(CVP)、심수출량지수(CO)、심장지수(CI)、전심사혈분수(GEF)、매박량지수(SVI)、흉강내혈용량지수(ITBI)、전심서장말기용량지수(GEDVI)등지표。분별기록수술전(T0)、유내동맥(LIMA)-전강지(LAD)문합후(T1)、전부혈관문합후(T2)、술후2 h(T3)、술후24 h (T4)적수거。결과30례균순리실시수술。T0시ABP、CVP、CO、GEF화SVI교T3、T4시명현강저(P＜0.05)，T0시ABP、CO、GEF화SVI교T1시명현강저(P＜0.05)，T0시ITBI화GEDVI교T3、T4시강저，T0시CI교T3、T4시명현상승(P＜0.05)。30례균회복순리，무외과병발증급여PiCCO조작상관적병발증。결론 PiCCO기술간첩가고，괄합우노년환자CABG적림상응용。
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.
