摘要
目的对比分析非体外循环冠状动脉旁路移植术(OPCAB)术后使用Swan-Ganz漂浮导管进行血流动力学监测对患者术后早期恢复的意义。方法解放军总医院心血管外科自2003年起常规在OPCAB术中放置Swan-Ganz导管。随机选择2003年之前及之后行OPCAB的患者各100例,分别作为非Swan-Ganz组(对照组)和Swan-Ganz组(实验组),对比两组患者术前及术后1、6、12、24h的平均肺动脉压(MPAP)和肺动脉楔压(PAWP),同时观察两组术后早期恢复情况,包括带气管插管时间、血管活性药物使用情况、主动脉球囊反搏使用率及ICU停留时间。结果两组患者无死亡,均痊愈出院。两组性别比、年龄、术前心功能、EF值、冠状动脉病变情况、合并症情况、术中搭桥支数及手术时间等均无显著性差异(P>0.05)。两组各时间点MPAP及PAWP水平及术后早期血管活性药物使用时间、主动脉球囊反搏使用率均无显著性差异(P>0.05),Swan-Ganz组带气管插管时间(10.36±3.14h)及ICU停留时间(36.47±6.25h)均明显少于非Swan-Ganz组(分别为15.72±2.23h、56.12±7.31h,P<0.05)。结论应用漂浮导管监测非体外循环冠状动脉搭桥患者血流动力学情况具有重要意义,能够促进患者的术后恢复。
Objective To retrospectively evaluate the significance of hemodynamies monitoring by Swan-Ganz catheter for the early postoperative recovery of patients undergone off-pump coronary artery bypass grafting （OPCAB）. Methods Swan-Ganz catheter was rou- tinely applied in OPCAB to monitor patients＇ hemodynamics postoperatively since 2003 in the Department of Cardiovascular Surgery of General Hospital of PLA. 100 patients who had undergone OPCAB before 2003 were randomly selected as the non-Swan-Ganz catheter group （control group）, and 100 patients after 2003 as Swan-Ganz catheter group （study group）. Mean pulmonary arterial pressure （MPAP） and pulmonary arterial wedge pressure （PAWP） before and 1, 6, 12, 24 hours after operation were measured in the two groups. Early postoperative recovery of patients, including trachea cannula duration, vasoactive agent application, usage of intra-aortic balloon pumping （IABP） and residence time in ICU were compared between the two groups. Results No death occurred in the two groups, and all patients were healing well. No significant differences existed in sex ratio, age, preoperative heart function, ejection fraction, degree of coronary artery stenosis, complications, number of bypass graft and operation time between the two groups （P〉0. 05）. And no significant differences ex- isted yet in MPAP and PAWP at all study time points between the two groups （ P〉0. 05）. Vasoactive agent application and usage of IABP in the two groups were similar （P〉0.05）, but the trachea cannula duration and residence time in ICU were significantly shorter in study group （10. 36±3. 14h and 36.47±6. 25h, respectively） compared with those in control group （15. 72±2.23h and 56. 12±7. 31h, respectively） （P〈0. 05）. Conclusion It may improve the early postoperative recovery of the patients who has undergone off-pump coronary artery bypass grafting that appling Swan-Ganz catheter to monitor perioperative hemodynamics.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2009年第3期345-346,共2页
Medical Journal of Chinese People's Liberation Army
