CAJ | 학술논문

目的探讨高渗胶体渗透压预充液体外循环(CPB)对冠脉搭桥患者术后早期血管外肺水和心肺功能的影响.方法经医院伦理委员会审核通过,2010年1月至2013年4月解放军第一一七医院40例择期冠脉搭挢术患者,按随机数字表法分为高胶体渗透压组(HES组,n=20)和对照组(晶体液组,n=20),两组预充液总量相等,观察比较两组患者术后早期心肺功能、血管外肺水(EVLW)、血浆胶体渗透压(COP)、液体输入总量及体重增减等指标.结果两组患者术前一般情况、CPB和主动脉阻断时间、冠脉吻合数均相似.CPB期间,HES组COP较转机前下降约22%[(16.7±3.9) 比(21.5±2.2) mmHg,P<0.05)],晶体液组下降超过50%[(10.7±2.0 ) 比(22.7±1.9 ) mmHg,P<0.05)].CPB结束后,HES组心脏指数(CI)显著高于晶体液组,且HES组的EVLW不变,而晶体液组增加21%,HES组的液体总入量也显著低于晶体液组[(715±544) 比 (1 951±487),P<0.05],晶体液组术后患者体重增加,但HES组则不增加[(1.4±1.1) 比(0.3±1.3),P<0.05],组间比较差异均有统计学意义(均P<0.05).其他血液动力学和心肺功能指标两组间各时间点比较均无显著差异.结论高胶体渗透压预充液CPB可改善冠脉搭桥患者术后早期的CI,减少EVLW生成,但对肺功能无明显影响.
목적 탐토고삼효체삼투압예충액체외순배(CPB)대관맥탑교환자술후조기혈관외폐수화심폐공능적영향.방법 경의원윤리위원회심핵통과,2010년1월지2013년4월해방군제일일칠의원40례택기관맥탑교술환자,안수궤수자표법분위고효체삼투압조(HES조,n=20)화대조조(정체액조,n=20),량조예충액총량상등,관찰비교량조환자술후조기심폐공능、혈관외폐수(EVLW)、혈장효체삼투압(COP)、액체수입총량급체중증감등지표.결과 량조환자술전일반정황、CPB화주동맥조단시간、관맥문합수균상사.CPB기간,HES조COP교전궤전하강약22%[(16.7±3.9) 비(21.5±2.2) mmHg,P<0.05)],정체액조하강초과50%[(10.7±2.0 ) 비(22.7±1.9 ) mmHg,P<0.05)].CPB결속후,HES조심장지수(CI)현저고우정체액조,차HES조적EVLW불변,이정체액조증가21%,HES조적액체총입량야현저저우정체액조[(715±544) 비 (1 951±487),P<0.05],정체액조술후환자체중증가,단HES조칙불증가[(1.4±1.1) 비(0.3±1.3),P<0.05],조간비교차이균유통계학의의(균P<0.05).기타혈액동역학화심폐공능지표량조간각시간점비교균무현저차이.결론 고효체삼투압예충액CPB가개선관맥탑교환자술후조기적CI,감소EVLW생성,단대폐공능무명현영향.
Objective To investigated the effect of a hyperoncotic CPB-prime with hydroxyethyl starch (HES) 6% (130/0.4) on extravascular lung water (EVLW) and post-pump cardiac and pulmonary functions.Methods This study plan approved by the hospital ethics committee review.In 40 randomized patients undergoing elective coronary artery bypass graft surgery (CABG), a colloid prime (COP:42.5 mmHg, HES-group,n=20) and a crystalloid prime (Ringer′s lactate, crystalloid group, n=20) of equal volume were compared with respect to the effects on cardiopulmonary function.Cardiac index (CI), mean arterial pressure (MAP),pulmonary capillary wedge pressure (PCWP), systemic vascular resistance index (SVRI), pulmonary artery pressure (PAP), pulmonary vascular resistance index (PVRI), alveolo-arterial oxygen difference (AaDO2), pulmonary shunt fraction (Qs/QT), extravascular lung water (EVLW), COP, fluid balance and body weight were evaluated peri-operatively.Results Pre-operative demographic and clinical data, CPB-time, crossclamp time and the number of anastomoses were comparable for both groups.During CPB, COP was reduced by 22% in the HES-group[(16.7±3.9) vs (21.5±2.2) mmHg, P<0.05] while it was reduced by more than 50% of the pre-CPB value [10.7±2.0 vs (22.7±1.9) mmHg,P<0.05] in the crystalloid group (P<0.05 HES-group vs. Crystalloid group).Post-CPB EVLW was unchanged in the HES-group but it was elevated by 21% in the crystalloid group (P<0.05 HES-group vs crystalloid group), CI was higher in the HES-group [(3.3±0.3) vs (2.7±0.7) L/min, P<0.05].Fluid balance was less in the HES-group (715±544 vs 1 951±487, P<0.05).Post-operative weight gain could be prevented in the HES-group but not in the crystalloid group (1.4±1.1 vs -0.3±1.3,P<0.05).No significant differences were seen for MAP, PAP, PCWP, SVRI, PVRI, AaDO2 and (Qs/QT) between the two groups at any time.Conclusions Hyperoncotic CPB-prime using HES 6% improves CI and prevents EVLW accumulation in the early post-pump period, while pulmonary function is unchanged.