体外与非体外循环冠状动脉旁路移植术的血流动力学对比研究

Comparative studies on perioperative hemodynamics in coronary artery bypass with or without cardiopulmonary bypass

目的分析体外与非体外循环冠状动脉旁路移植术围术期的血流动力学变化,以指导临床治疗。方法回顾性分析2006年1-6月行搭桥手术的30例患者,其中非体外循环下搭桥手术(OPCAB)组18例,传统体外循环下搭桥手术(CCABG)组12例,OPCAB组使用血管稳定器(OctopsⅢ型)固定靶血管,CCABG组常规插管建立体外循环,使用乳内动脉和大隐静脉与冠状动脉靶血管吻合。记录术中、术后相应时间点各项血流动力学指标的变化以及围术期相关参数的变化。结果CCABG组麻醉时间、术中出血量、液体用量和呼吸机辅助时间明显高于OPCAB组,而术后血细胞比容(HCT)明显低于OPCAB组(P<0.05)。麻醉诱导期间两组心率(HR)、桡动脉收缩压(SAP)、桡动脉舒张压(DAP)和平均动脉压(MAP)等血流动力学指标均较术前明显降低(P<0.05),但两组间比较无显著差异。在关胸前后及回ICU后1h、6hCCABG组中心静脉压(CVP)明显高于OPCAB组,而左室每搏功指数(LVSWI)明显低于OPCAB组。结论两种手术方式均能改善心脏功能,但OPCAB血流动力学调控较为复杂。

Objective To analyze the hemodynamic changes during coronary artery bypass grafting with or without cardiopulmonary bypass.Methods Thirty patients undergone coronary artery bypass grafting from January to June,2006 were retrospectively analyzed.Among them,12 patients were operated on with cardiopulmonary bypass（CCABG）and 18 without cardiopulmonary bypass（OPCAB）.The stabilizator（type Octops III）was used to fix target vessels in OPCAB group.In CCBAG group,the extracorporeal circulation was used routinely,and internal mammary artery and saphenous vein were used to anastomose with target branches of coronary artery.The hemodynamic changes at different time points during and after operation were monitored,and the relevant parameters were also recorded.Results The anaesthesia time,intraoperative blood loss and fluid input,and ventilating time after operation in CCABG group were significantly higher than those in OPCAB group,and the postoperative haematocrit（HCT）was significantly lower in CCABG group than that in OPCAB group（P〈0.05）.During the anesthesia induction period,the hemodynamic parameters such as heart rate（HR）,radial systolic arterial pressure（SAP）,diastolic arterial pressure（DAP）,and mean arterial pressure（MAP）were obviously lower as compared with those before operation,but showing no statistical significance.The central venous pressure（CVP）was significantly higher in CCABG group than that in OPCAB group before and after closure of thoracic incision,and 1 and 6 hours after being sent to ICU.Meanwhile,the left ventricle stroke work index（LVSWI）was significantly lower in CCABG group than that in OPCAB group.Conclusion Both CCABG and OPCAB can improve heart functions,but the regulation of hemodynamics in OPCAB is more complicated.