动脉压力波形分析技术在急性等容血液稀释中的应用

Application of arterial pressure waveform analysis in acute normovolemic hemodilution

目的应用动脉压力波形分析技术(FloTrac/Vigileo系统)来观察心脏手术患者急性等容血液稀释(ANH)时的血流动力学变化。方法20例拟在心肺转流(CPB)下择期行心脏手术患者随机均分为A、B两组,全麻后行ANH,目标血细胞比容(Hct)为32%,放血速度分别为20ml/min(A组)和40ml/min(B组)。于ANH前(T0)、ANH开始后5min(T1)、10min(T2)、ANH结束时(T3)、ANH结束后10min(T4)记录HR、MAP、CVP及FloTrac/Vigileo系统测得的心脏指数(CI)、每搏量指数(SVI)、全身血管阻力指数(SVRI)、每搏量变异度(SVV)等指标。结果两组ANH期间血流动力学变化均无统计学意义;但SVV在T1～T3时较T0时明显增高(P<0.01),而且B组SVV明显高于A组(P<0.05)。结论心脏手术患者术前进行ANH是安全的,动脉压力波形分析技术能对其进行方便的监测。SVV能预测机体对输液治疗的反应。

Objective To observe the hemodynamic variance of cardiac surgery during acute norrnovolemic hernodilution （ANH） by arterial pressure waveform analysis （ FloTrac/Vigileo system）. Methods Twenty patients undergoing selective cardiac surgery under cardiopulmonary bypass（CPB） were randomly divided into 2 groups with 10 cases each. The target Hct was 32 per cent after ANH, and the rates of bloodletting were 20 ml/min（group A）and 40 ml/min（group B）. HR, MAP, CVP and CI, SVI, SVRI,SVV were measured by FloTrac/Vigileo system before ANH （T0）, at 5 min（T1 ）, 10 min during ANH（T2）,attheendofANH（T3） and 10 min after ANH（T4）. Results The hemodynamics of two groups had no significant variation. SW was significantly higher at T1-T3 than that at To （P〈0.01）, which was significantly higher in group B than that in group A（P〈0. 05）. Conclusion ANH in cardiac surgery was safe, which can be monitored with conveniently by arterial pressure waveform analysis. SW could be an indicator for predicting the response to fluid infusion during ANH.