摘要
目的:采用压力记录分析技术(PRAM)研究完全肺静脉异位引流(TAPVC)患儿的围术期血流动力学变化。方法:本研究共纳入了在全麻下行完全性肺静脉异位引流(TAPVC)矫治手术的患儿42例,入室后常规麻醉诱导,气管插管后行桡动脉或股动脉穿刺置管连续监测动脉血压,并连接Mostcare-PRAM监测仪。在全麻诱导结束手术开始前(T1),切开心包肝素化前(T2)、拔除主动脉插管后(T3)和术毕离室前(T4)各个时间点采集心率(HR)、收缩压(Sys P)、舒张压(Dia P)、重脉压(Dic P)、体循环阻力(SVR)、每搏量指数(SVI)、心指数(CI)、每搏量变异度(SVV)、心脏循环效率(CCE)和最大压力梯度(dp/dt)血流动力学参数。结果:CCE中T3比T1、T2均显著降低(P<0.01),T4比T3均显著增高(P<0.01);HR中T2、T3、T4比T1均显著增高(P<0.01),T3、T4比T2均显著增高(P<0.01);SVR中T3比T1、T2均显著增高(P<0.01),T4比T1、T2均显著增高(P<0.05);SVI中T3、T4比T1均显著降低(P<0.05);SVV中T2比T1显著降低(P<0.05),T3比T2显著增高(P<0.01);DPDT中T3比T1、T2均显著增高(P<0.05),T4比T1、T2均显著增高(P<0.01),T4比T3显著增高(P<0.05)。CI各个时间点之间不存在显著差异。结论:TAPVC患儿围术期易发左心衰,因此应进行严格的容量控制。应用PRAM法监测,量化反映术中前后负荷和心脏收缩功能的变化规律,能够为畸形矫治前后血管活性药物的选择和容量治疗等提供依据。
Objective： To study the hemodynamic changes of patient undergoing total pulmonary venous allostatic connection surgery by using pressure recording analysis technique（ PRAM） Methods： 42 patients undergoing Total pulmonary venous allostatic connection（ TAPVC） correction were selected. Radial or femoral artery pressure monitoring were set up after induction of anesthesia and trachea intubation,hemodynamic parameters were monitored with most-care device PRAM. Arterial pressure,Heart Rate,Cardiac Index,Systemic vascular Resistance,Stroke Volume Index,Cardiac Cycle Efficiency,Stroke Volume Variation are recorded by MOSTCARE monitor before surgical incision（ T0）,after cut pericardium（ T2）,after removal of aortic cannula（ T3）,and end of operation（ T4）. Results： T3 was significantly lower in CCE than T1 and T2（ P〈0. 01）,and T4 was significantly higher than T3（ P〈0. 01）. In HR,T2,T3 and T4 were significantly higher than T1（ P〈0. 01）,and T3 and T4 were significantly higher than T2（ P〈0. 01）,T3 was significantly higher than T1 and T2 in SVR（ P〈0. 01）,and T4 was significantly higher than T1 and T2（ P〈0. 05）,T3 and T4 in SVI were significantly lower than T1（ P〈0. 05） In SVV,T2 was significantly lower than T1（ P〈0. 05）,and T3 was significantly higher than T2（ P〈0. 01） T3 was significantly higher than T1 and T2 in DPDT（ P〈0. 05）,and T4 was significantly higher than T1 and T2（ P〈0. 01）,and T4 was significantly higher than T3（ P〈0. 05） There was no significant difference between time points in CI. Conclusion： TAPVC patients are prone to have left heart failure during perioperative period. Therefore,the volume capacity should be strictly controlled. The hemodynamic changes of TAPVC patients can be quantitatively monitored by the PRAM technology,the changes of cardiac systolic function,cardiac preload and afterload can guide the use of vasoactive drugs and hypovolemic treatment.
作者
侯宇希
韩丁
欧阳川
HOU Yuxi;HAN Ding;OUYANG Chuan(Department of Anesthesiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)
出处
《心肺血管病杂志》
2018年第9期857-861,共5页
Journal of Cardiovascular and Pulmonary Diseases
关键词
完全性肺静脉异位引流
压力记录分析法
血流动力学
Total pulmonary venous allostatic connection
Pressure recording analysis technique
Hemodynainic changes
