神经外科围术期心输出量测定对心功能评估的意义

Significance of perioperative cardiac output monitoring in assessing cardiac function of neurosurgical patients

目的:研究二氧化碳部分重复吸入法测量心输出量(partialCO2re-brethingcardiacoutput,RBCO)与经食管超声多普勒法测量心输出量(transesophagealdopplercardiacoutput,TECO)用于监测神经外科患者围术期心输出量的相关性,比较其应用可靠性。方法:选择2003-03/11首都医科大学附属北京天坛医院麻醉科29例择期颅脑手术患者,麻醉诱导气管内插管后接呼吸机行间歇正压通气。分别于手术开始、颅骨钻孔、开骨瓣、剪开硬膜、取肿瘤、止血及手术结束时各时点采用RBCO和TECO同步监测术中心输出量的变化。采用直线回归方法分析两种测定方法的相关性。结果:RBCO和TECO结果有显著相关性(r=0.78,P<0.01),回归方程为RBCO=0.88TECO+0.63。结论:RBCO方法简便、无创,与TECO测定结果具有良好的相关性。

AIM:To study the correlation between partial CO2 rebreathing method(RBCO) and transesophageal Doppler(TECO) for perioperative cardiac output(CO) monitoring in neurosurgical patients. METHODS:Twenty-nine scheduled for craniocerebral surgery were selected from the Department of Anesthesiology,Beijing Tiantan Hospital Affiliated to Capital University of Medical Sciences during March and December 2003.After endotracheal intubation induced by anesthesia,breathing apparatus was connected to perform intermittent positive pressure ventilation.Intraoperative CO changes in the 29 neurosurgical patients at the time points of the beginning of surgery,cranial drilling,bone flap craniotomy,dura mater shearing,tumor-taking out,hemostasis and the end of surgery were simultaneously measured with partial RBCO and TECO.The correlation between the two methods of partial RBCO and TECO were analyzed with linear regression method. RESULTS:A significant correlation was found between RBCO and TECO for CO monitoring(r=0.78,P< 0.01).The regression equation is RBCO=0.88 TECO+0.63. CONCLUSION:RBCO used for CO monitoring is easily and simply operated without trauma to the neurosurgical patients.There is a good correlation between cardiac outputs measured with RBCO and TECO.