容量负荷下经食管超声多普勒与有创性肺动脉导管测定血流动力学指标的相关性分析

Hemodynamic parameters determined by transesophageal doppler echocardiography and pulmonary artery catheter after volume administration in patients receiving off-pump coronary artery bypass surgery:a correlation analysis

目的:采用经食管超声多普勒(transesophageal echocardiography,TEE)与有创性肺动脉导管(pul monary artery cath-eter,PAC)技术同步测定非体外循环冠状动脉旁路移植术(OPCAB)中容量负荷前后血流动力学相关指标的变化,分析二者的相关性,探讨TEE监测OPCAB术中容量负荷的价值。方法:择期行OPCAB术患者20例,采用TEE测量二尖瓣血流频谱(MVF),同步采用PAC技术测量中心静脉压(CVP)、肺动脉楔压(PCWP)、肺动脉平均压(PAP)、每搏量(SV)等指标。术中患者10 min内给予5 ml/kg羟乙基淀粉130/0.4氯化钠注射液(万汶)作为容量负荷,输液后测定上述指标,并与开胸前、关胸后分别测得的基础值进行比较,以SV升高>10%作为容量负荷有效的标准。分析TEE及PAC同步测量所得指标与SV的相关性。结果:20例患者中有14例在第一次容量负荷时SV升高>10%,而在第二次容量负荷时仅6例。输液有效及无效组PCWP均明显增加(P<0.05)。输液有效组CO、CI、SV较输液前明显增加(P<0.05),输液有效组MVF舒张早期峰值血流速度(MVe)、舒张早期峰值血流速度时间积分(VTIe)、VTIe与舒张晚期峰值血流速度时间积分(VTIa)之和(VTIe+a)较输液前有明显增加(P<0.05)。而MVF舒张晚期峰值血流速度(MVa)、VTIa、MVe减速时间(EDT)变化差异无统计学意义。各指标与SV的相关分析结果:MVe(r=0.36,P<0.01)、VTIe(r=0.63,P<0.01)、VTIe/VTIa(r=0.67,P<0.01)、VTIe+a(r=0.77,P<0.01)、PCWP(r=0.35,P<0.01)。输液后混合静脉血氧饱和度(SvO2)略有升高(P<0.05)。结论:TEE监测各指标与SV相关性不等,其中血流速度时间积分(VTI)与SV显著正相关,能较准确反映左室前负荷,值得进一步研究以用于指导临床用药。

Objective：To investigate the changes of hemodynamic parameters by transesophageal doppler echocardiography（TEE） and pulmonary artery catheter（PCA） before and after volume administration in patients receiving off-pump coronary artery bypass（OPCAB） surgery,to analyze the correlation between the two methods,and to discuss the value of TEE in monitoring the preload during OPCAB.Methods： Twenty patients who were to receive OPCAB were enrolled in the present study.TEE was used to determine the mitral valve flow（MVF）.Simultaneously,the central vein pressure（CVP）,pulmonary capillary wedge pressure（PCWP）,pulmonary artery pressure（PAP）,mixed venous oxygen saturation（SvO2）,cardiac output（CO）,cardiac index（CI）,and stroke volume（SV） were examined during OPCAB by PCA.The above parameters were recorded before and immediately after volume infusion（5 ml/kg,in 10 minutes）.Patients with SV increased by 〉10% were taken as effective responders.Pearson correlation analysis was used to examine the relationship of SV with the results of TEE and PAC.Results： There were 14 effective responders after the first volume load,and only 6 after the second infusion.Compared with the baseline values,PCWP of all the patients,and CO,CI and SV of the effective responders increased significantly after volume loading（P〈0.05）;the values of MVe,MTIe,and VTIe＋a also increased significantly after volume loading（P〈0.05）;and there were no significant changes in MVa,VTIa,MVedt values after volume loading.The results of correlation analysis of SV with other parameters were： MVe（r=0.36,P〈0.05）,VTImve（r=0.63,P〈0.05）,VTIe/VTIa（r=0.67,P〈0.01）,VTIe＋a（r=0.77,P〈0.01）,and PCWP（r=0.35,P〈0.01）.SvO2 was increased after infusion（P〈0.05）.Conclusion： The relationship of TEE parameters with SV is variable.There is a significant positive correlation between SV with VTIe and VTIe＋a;and VTI can be used to evaluate the preload of left ventricular,which should be further studied to guide clinical medication.