右心室舒张末期容量监测用于肝移植术中容量管理的临床研究

Clinical study on monitoring right ventricular end-diastolic volume in volume management during orthotopic liver transplantation

目的:探讨右心室舒张末期容量监测(righ tventricular end-diastolic volume index,RVEDVI)用于肝移植术中容量管理的可行性。方法:择期肝移植手术患者32例,使用连续心输出量测定热稀释导管774HF75,于诱导前(T0)、手术前(T1)、无肝前期(T2)、门静脉(PV)阻断后30min(T3)、门静脉开放后10min(T4)、门静脉开放后30min(T5)、门静脉开放后60min(T6)、门静脉开放后120min(T7)和术毕(T8)测定RVEDVI、右心室射血分数(ejec-tion fraction,EF%)、心输出量指数(continuous cardiac index,CCI)、中心静脉压(central venous pressure,CVP)、肺动脉压(mean pulmonary arterial pressure,MPAP)、肺动脉闭合压(pulmonary artery obstruction pressure,PAOP),并计算每搏量指数(stroke volume index,SVI)等指标。计算各时点SVI与CVP、PAOP和RVEDVI之间的相关性,寻找能够准确反应肝移植患者容量状态的首选参数。结果:手术期间RVEF平均为(42.04±9.40)%。各时间点RVEDVI与SVI明显相关(P<0.05),PAOP、CVP与SVI间无显著相关性。结论:RVEDVI可以作为评价肝移植患者容量状态的优选监测参数。

Objective：To explore the feasibility of guiding the volume management during orthotopic liver transplantation by right ventricular end-diastolic volume index （RVEDVI）. Methods： Thirty-two patients who accepted OLT were studied during operation. A modified pulmonary artery catheter equipped with a fast response thermistor （774HF75） was used to determine RVEDVI, EF, CCI, CVP, MPAP, PAOP and SVI. The above-mentioned hemodynamic measures were taken in 9 phases： To, before induction of anesthesia; T1 ,before operation; T2 , pre-anhepatic phase ; T3 , 30 minutes after PV occlusion ; T4, 10 minutes after graft reperfusion; T5 , 30 minutes after graft reperfusion; T6, 60 minutes after graft reperfusion; T7, 120 minutes after graft reperfusion; and T8, at the end of surgery. The linear regression analyses of SVI and CVP, SVI and PAOP, SVI and RVEDVI in each phase were calculated, and the best measure of representing the volume of the OLT patient was selected. Results： The variation of the RVEF value was （42.04 ±9.40 ）%. Linear regression analyses showed a significant correlation between RVEDVI and stroke volume index （SVI） in each phase（P 〈 0.05）. No relationships were found between PAOP and SVI, CVP and SVI. Conclusion： RVEDVI may be the best hemodynamic measure of evaluating the volume of the OLT patients.