肺移植麻醉中血流动力学监测的临床研究

Clinical research of hemodynamics monitoring in lung transplantation

目的观察肺移植麻醉中Swan-Ganz漂浮导管和脉搏指示连续心排血量(PiCCO)监测的血流动力学指标及其在肺移植手术中的应用价值。方法 23例终末期肺病患者,17～72岁,ASAⅢ或Ⅳ级。在麻醉诱导插入双腔支气管导管后,于颈内静脉穿刺置入Swan-Ganz漂浮导管,取左侧股动脉穿刺置入PICCO导管。分别记录麻醉后双肺通气(T0)、单肺通气30min(T1)、肺动脉阻断10min(T2)、肺动脉开放后30min(T3)、术毕(T4)时的血流动力学数据和PiCCO监测数据,对肺动脉压(PAP)、心排血量(PCCO)与间断心排血量(CO),全心舒张末期容积指数(GEDI)、胸腔内血容积指数(ITBI)、中心静脉压(CVP)、肺动脉闭合压(PAOP)与每搏量指数(SVI),血管外肺水指数(ELWI)与肺血管通透性指数(PVPI)行相关性分析。结果与T0时比较,T1、T2时PAP、脉压变异(PPV)升高和PCCO、CO降低,HR增快(P<0.05);与T1和T2时比较,T3和T4时PAP下降,PCCO、CO升高(P<0.05);T3和T4时GEDI、SVI、ELWI、ITBI、PVPI明显高于T0时(P<0.05);GEDI与SVI显著正相关(r=0.66,P<0.01),ITBI与SVI显著正相关(r=0.65,P<0.01),ELWI与PVPI高度正相关(r=0.85,P<0.01),PAOP与SVI不相关(r=0.18)。结论肺移植时可引起血流动力学紊乱,PiCC0技术与Swan-Ganz漂浮导管结合运用能更全面地对肺移植术中的心肺功能进行评估。

Objective To evaluate the hemodynamics during lung transplantation via PICCO and Swan-Ganz monitoring.Methods Twenty-three ASA Ⅲ or Ⅳ patients,aged 17 to 72 years,undergoing lung transplantation surgery were involved in this study. All patients received central venous,Swan-Ganz,and PiCCO catheter placement. The hemodynamic parameters such as PAP,PCCO,CO,GEDI,ITBI,CVP,PAOP,SVI,ELWI and PVPI were recorded after induction（T0）,30 min after one-lung ventilation（T1）,10 min after pulmonary artery clamping（T2）,30 min after pulmonary artery unclamping（T3）,on the end of surgery（T4）. Results PAP and PPV increased but PCCO and CO decreased at T1 and T2when compared with T0 （P0.05）. PCCO and CO increased at T3 and T4 compared with T1 and T2（P0.05）.GEDI,ITBI,ELWI and PVPI increased at T3 and T4 than T0 （P0.05）. GEDI was correlated to SVI （r=0.66,P0.01）,TTBI was correlated to SVI（r=0.65,P0.01）. PAOP was correlated to SVI（r=0.18）. ELWI was correlated to PVPI（r=0.85,P0.01）.Conclusion The hemodynamics is unstable during lung transplantation. PICCO together with Swan-Ganz is a good choice to monitor the cardiac and pulmonary function during lung transplantation.