容量型漂浮导管在非体外循环冠状动脉移植术中的应用

Application of the Modified Pulmonary artery Catheter during off-pump coronary Artery Bypass Grafting

目的应用新型容量型漂浮导管观察非体外循环冠状动脉旁路移植术(OPCABG)中吻合不同的血管分支时血液动力学指标的变化,为选择有效的指标提供参考。方法18例患者行OPCABG,监测术前、吻合前降支、对角支、右冠状动脉和近端5个时间段的中心静脉压(CVP)、肺毛细血管楔压(PCWP)、右室舒张末期容积指数(RVEDVI)以及右室射血分数(RVEF)。结果与术前相比,吻合前降支、对角支、右冠状动脉时CVP和PCWP均较术前显著增高(P<0.05),RVEDVI和RVEF无显著差异。结论OPCABG术中吻合各支血管期间,不能仅通过PCWP和CVP来判定心室容量负荷,应参考RVEDVI值并结合RVEF的变化综合考虑右室容量负荷、收缩性和后负荷的动态变化。

Objective To evaluate the hemodynamic parameters through the Modified Pulmonary artery Catheter during Off-pump Coronary Artery Bypass Grafting.Methods Monitoring of CVP, PCWP, RVEDVI, RVEF while baseline , anastomoses of left anterior descending coronary artery(LAD), diagonal coronary artery, right coronary artery(RCA) and proximal in 18 patients underwent OPCABG.Results Compared with baseline, the values of CVP and PCWP increased during anastomoses of left anterior descending coronary artery(LAD), diagonal coronary artery, right coronary artery(RCA) (P<0.05) while the values of RVEDVI and RVEF without significant change.Conclusion RVEDVI and RVEF are better indicators in the infusion therapy during OPCABG than CVP and PCWP.