冠状动脉旁路移植术围手术期右心室容量的变化及其意义.pdfVIP

上海医学 2004 年第 27 ~量自 7 期 . 479 ? ·论著· 冠状动脉旁路移植术围于术期右心室容量 的变化及其意义 肖洁玉祥瑞周洁孙大金 {摘要] 罔的 应用新型有创血流动力学监测仪观察冠状动脉旁路移模术(CABG)围术期有心窒容量的变 化，并探讨其意义。方法 40 例冠心病患者行 CABG，连续监测患者的心排血量(CO) 、心脏指数(CI)、平均动脉 压(MAP)、肺毛细血管模压(PCWP) 、全身血管阻力 (SVR)、右心射血分数(RVEF) 、有窒舒张来容积(RVEDV) 、 有蜜收缩来睿积(RVESV)等血流动力学参数。结果 与术前相比，CO 、 CI 、 RVEF 在体外循环转机前呈下降趋 势，体外转机停机后 CO、CI 、RVEF、RVEDV 值逐渐上升(P O. 01) ，术后早期再次下降，至术后 8h 叉逐渐升 高 ;SVR 在体外循环转机前也有所下降(P0.05) ，在术后早期逐步升高，眉又下降。蜻论 行 CABG 手术的患 者在围术期有心功能代偿性增加;术后早期患者均出现不同程度低心排血量的表现，但很快就能被机体代偿。 有心容量监测有助于囤术期监测，指导l临床治疗。 [关键调 1 有心容量监测:持续心排血量监测;血流动力学;冠状动脉旁胳移植术 SI伊liflcBnωof rlght ventrlcular volume chan伊s during 仰ron创Y artery bypass 伊Bfting XIAO]ie , WANGXian- grui , ZHOU ]ie , et al. De，阳rtment 01 Anesthesiology , Renji Hosρital ， Shanghai 岛cond Medical Unìversìty , Shanghai 200127 , China [Abstract] Objective To evaluate the perioperative changes of right ventricular volume in patients withωro- nary artery bypass grafting (CABG) through a new hemodynamic monitor. Methods By continuous monitoring of CO ,CI ,MAP ,PCWP ,SVR.RVEF , RVEDV.RVESV using Vigilance CCO/S~ monitor (USA) in 40 patients un- derwent CABG. Rωults CO , CI , RVEF values were some what low in ∞mpared with those in the preoperative peri- od before the bypass stage (P 0.05). They were then increased in the post-bypass stage (P 0.01); whereas during the early pωtoperative period. CO. 口， RVEF and RVEDV were gradually increased; SVR also decreased in the pre- bypass stage (P O. 05); after CABG , it began to increase till the operation. varying degrees then it started to de- crease again. Concluslon During perioperatìve stage of CABG , patients right ventricular function are enforced and low cardiac output manifestations were shown during the early stage of po西toperative period. but rapidly overωme by body compensatìon. The right ventricular volume monitor is helpful for perioperative monitoring and guid四 the clinical management. (Shanghai Med J , 2004 ,27:479-481) [Key wo地] Right ventricular volumes monitor; Conti