两种方法评估冠状动脉旁路移植术患者心脏收缩功能的比较.docVIP

两种方法评估冠状动脉旁路移植术患者心脏收缩功能的比较 摘要：目的 评估经食管超声心动图（TEE）左室流出道（LVOT）测量心脏排血量（COLVOT）和经Swan-Ganz肺动脉导管测量心脏排血量（COPAC）的一致性及左室射血分数（LVEF）、左室面积变化分数（LVFAC）、右室射血分数（RVEF）之间的相关性。方法 择期行冠状动脉旁路移植术的患者12例，性别不限，年龄18～70岁，体重56～84kg，ASA分级Ⅱ或Ⅲ级，术前NYHA心功能分级Ⅱ级或Ⅲ级。麻醉诱导及术中维持均采用全凭静脉麻醉。麻醉诱导气管插管后置入Swan-Ganz肺动脉导管并放置TEE探头，于插管后（T0）、停止体外循环转机后或非体外循环手术血管吻合完成后15分钟（T1）、30分钟（T2）和60分钟（T3）的数据。统计分析采用Bland-Altman 一致性检验和Pearson相关系数检验。结果COPAC为（4.82±1.32） L/min，COLVOT为（4.57±1.30）L/min，两者具有良好的相关性（r=0.655，P＜0.001），COPAC和COLVOT的偏差为0.28L/min（95%CI为-0.04～0.60L/min），一致性界限为-1.90～2.46L/min。LVEF与LVFAC呈正相关（r=0.662，P＜0.001），而与RVEF 无相关性（r=－0.218，p＞.05）。LVEF与LVFAC偏差为15.36%（95%CI为46%～18.29%），一致性界限为4.68%～35.43%，LVEF与RVEF的偏差为34.40%（95%CI为29.69%～39.10%），一致性界限为-2.01%～66.78%。结论 TEE经左室流出道测量心脏排血量和Swan-Ganz肺动脉导管测量心脏排血量之间有较强的相关性但一致性较差，TEE和PAC不能互相替代，而左室射血分数与左室面积变化分数之间存在明显偏差但有较好的相关性。 关键词： 经食道超声心动图；心排血量；肺动脉导管；左室流出道；射血分数；面积变化分数 Comparison of two methods to determine Cardiac systolic function in patients undergoing coronary artery bypass grafting Abstract: Objective: To determine if the cardiac output(CO) measured by transesophageal echocardiography (TEE) through the left ventricular outflow tract(LVOT) agrees with that measured by pulmonary artery catheter(PAC) and analysis the correlation between left ventricular ejection fraction(LVEF)，left ventricular function of area change(LVFAC) and right ventricular ejection fraction(RVEF)．Methods: Twelve patients with ASA Ⅱ～Ⅲ(NYHA Ⅱ or Ⅲ)，aged 18-70 years old，weighing 46-72 kg，undergoing coronary artery bypass grafting，were studied．Total intravenous anesthesia was used for induction and maintenance of anesthesia．After tracheal intubation，the Swan-Ganz catheter was placed in right internal jugular venous and TEE probe was placed in the esophagus．The data were measured and recorded after tracheal intubation，15，30 and 60 mins after termination of cardiopulmonary bypass (CPB) or finished vascular anastomosis in off-pump CABG．Statistical analysis was made with Bland-Altman plot and Pearson correlation c