持续心排量监测评估重症瓣膜病人手术前后血流动力学的变化

Evaluation of Hemodynamics in Severe Valve Replacement Patientsby Using Continuous Cardiac Output Monitor before and after Operation

目的 观察重症瓣膜病人手术前后全身血流动力学及氧供需平衡变化 ,评价持续心排量监护仪监测重症瓣膜病人手术前后心功能状况的价值。方法 重症瓣膜置换手术病人 2 4例 ,手术麻醉前、术后即刻、术后 2、4、6h利用持续心排量监测仪测定并计算心指数 (cardiacindex ,CI)、每搏指数 (strokevolumeindex ,SVI)、外周阻力指数 (systemicvascularresistanceindex ,SVRI)、肺血管阻力指数 (pulmonaryvascularresistanceindex ,PVRI)、左室每搏功指数 (leftventricularstrokevolumeindex ,LVSWI)、右室每搏功指数 (rightventricularstrokevolumein dex ,RVSWI)、混合静脉血氧饱和度 (SvO2 )、氧供指数 (DO2 I)、氧耗指数 (VO2 I)等指标 ,连接HP多功能检测仪测定右房压 (RAP)、肺动脉平均压 (MPAP)、肺动脉楔压 (PAWP)。结果 本组病例术后CI、LVSWI、SvO2 、DO2 I、SVI较术前基础值明显升高 ,术后SVRI、PVRI、MPAP、PAWP较术前下降明显 ;其余指标较术前变化不明显。结论 重症瓣膜患者手术后血流动力学较术前明显好转 ,心功能较前明显改善 。

Objective To examine hemodynamics in severe valve replacement patients by using continuous cardiac output monitor before and after operation and to evaluate the cardiac function.Methods Data of CI, SVI, SVRI, PVRI, LVSWI, RVSWI,SvO 2, DO 2I, VO 2I by using continuous cardiac output monitor and RAP, MPAP, PAWP, by connecting HP multifunction monitor before operation, shortly after operation,2, 4, 6 hours after operation, were determined for 24 patients who underwent valve replacements. Results In this group, levels of CI, LVSWI, SvO 2, DO 2I, SVI after operation were obviously higher than the baseline values before operation, and levels of SVRI, PVRI, MPAP, PAWP decreased more significantly. There were no significant changes in other indices.Conclusion Hemodynamic indices become better after operation and cardiac function improves apparently. Continuous cardiac output monitor can provide us a new reliable way to evaluate the effectiveness after cardiac valve replacement.