摘要
目的 了解不停跳冠脉搭桥 (OPCAB)患者围术期氧代谢和血流动力学的变化。方法 测定 15例OPCAB患者①诱导后 ,②取乳内A ,③前降支搭桥 ,④右冠支搭桥 ,⑤回旋支搭桥 ,⑥对角支搭桥 ,⑦吻合主A ,⑧术毕 ,⑨术后 2h , l媢斒鹾?6h , l媣暿鹾?16h ,共 11个时点的血流动力学 (CO ,CI ,HR ,ABP ,CVP ,PAP ,PCWP)及计算值 (SVR ,PVR ,SVI ,LVSWI ,RVSWI) ,在① ,② ,⑦ ,⑧ ,⑨ , l媢?, l媣暪?7个时点同时抽取肺动脉和桡动脉血做血气分析 ,计算氧代谢指标 (DO2 I ,VO2 I ,O2 ER)。结果 氧代谢变化 :DO2 I和VO2 在① ,② ,⑦ ,⑧ ,⑨呈正相关 ,(P <0 .0 5 ) ,提示存在氧供病理性依赖。DO2 I术后⑨ , l媢?, l媣曌槊飨愿哂谑踔懈髯?(P <0 .0 5 ) ,但仍然低于正常值 ;VO2 I在术后⑧ ,⑨ , l媢?, l媣曌槊飨愿哂谑踔凶?(P<0 .0 5 ) ;O2 ER在⑦明显高于①组 ,(P <0 .0 5 )。血流动力学变化 :CO、CI ,HR在术后⑨ , l媢?, l媣曌槊飨源笥谑踔懈髯?,(P<0 .0 5 ) ,但CO、CI仍然低于正常值 ;SVR在术后 (⑨ , l媢?, l媣曌?)明显 <术中各组 (P <0 .0 5 ) ;PVR各组无明显差别 (P >0 .0 5 ) ;CVP ,mPAP ,PCWP在搭桥期间明显 >其他各组 (P <0 .0 5 ) ;LVSWI在搭桥期间 (⑤ ,⑥组 )明显 <①组 ,(P <0 .0 5 ) ;结论?
Objective To investigate the changes of perioperative oxygen metabolism and hemodynamics in patients with off pump coronary artery bypass surgery.Methods Fifteen patients under went off pump coronary artery bypass(OPCAB) in this hospital.The radial artery was cannulated for direct measurement of arterial pressure.Anesthesia was induced with midazolam,fentanyl and vecuronium and maintained with enflurane inhalation and intermittent bolus of fentanyl and propofol and vecuronium.After tracheal intubation,the patients were mechanically ventilated and blood gases were maintained within the normal range.After induction of anesthesia,7F Swan Ganz catheter was inserted into the right jugular vein.Cardiac output(CO)and mixed venous oxygen saturation were continuously monitored by cardiac output monitor(Baxter,Vigilance);ECG(ST analysis),ABP,CVP,PAP,PCWP,SpO 2 were also continuously monitored during operation.Systemic vascular resistance(SVR),pulmonary vascular resistance(PVR),left ventricular stroke work index(LVSWI),right ventricular stroke work index (RVSWI),stroke volume index(SVI)were calculated at the time of after induction①,taking left luma artery②,anterior descending branches distal anastomoses③,post right ventricular branches distal anastomoses④,R.circumflexus distal anastomoses⑤,diagonal branches distal anastomoses⑥,aorta proximal anastomoses⑦,the end of operation⑧,2h⑨,6h10and 16h11after operation.Arterial and mixed venous blood samples were taken at the ①,②,⑦,⑧,⑨,10,11,oxygen delivery index(DO 2I)and oxygen consumption(VO 2I)and oxygen extraction ratio(ERO 2)were calculated. Results DO 2I and VO 2I were positively correlated in ①,②,⑦,⑧,⑨,( P <0.05).DO 2I and VO 2I were significantly higher in postoperation(⑨,10,11),( P <0.05),but DO 2I was lower than normal value.O 2ER was significantly higher in (⑦,⑧)than in①,( P <0.05).During postoperation(⑨,10,11),CO,CI,HR were significantly higher than others( P <0.05),but CO,CI were lower than normal value.In distal anastomoses stages(④,⑤,⑥),CVP,PCWP,mPAP were significantly higher than others( P <0.05);LVSWI was significantly lower in (⑤,⑥)than in ①( P <0.05).Conclusion There exist low cardiac output and pathologic DO 2I dependent VO 2I in high risk coronary heart disease patients.During distal anastomoses,the OPCAB patient's hemodynamics is unstable,therefore special management skills are needed.The OPCAB patient's hemodynamics and oxygen metabolism are improved after operation,but the values of relevant indices are lower than normal,so it is still necessary to support their hemodynamics and oxygen delivery(DO 2).
出处
《四川医学》
CAS
2002年第2期113-116,共4页
Sichuan Medical Journal
