单肺移植术中心脏局部低温对血流动力学的影响

Effect of heart cooling on hemodynamics during one lung transplantation

目的观察非体外循环下行单肺移植术,术中供肺吻合时局部心脏低温对血流动力学的影响。方法 26例终末期肺疾病患者,气管插管全身麻醉下行肺移植术。取第一侧患肺切除术后供肺吻合前(T0)、供肺吻合中心脏局部低温30min(T1)、供肺吻合中心脏局部低温60min(T2)作为观察时点,比较各时点的血流动力学数据。结果与T0比较,T1、T2的食管温和血温明显降低,T1、T2的心输出量(CO)和心脏指数(CI)明显降低。结果与T0比较,T1、T2的TE和TB明显降低,T1、T2的心输出量(CO)和心脏指数(CI)明显降低。结论单肺移植术中供肺吻合时,单侧肺通气、全身常温、心脏局部低温这一特殊麻醉状态下,尽管已对患者做了相应的保温及药物干预措施,对血流动力学的影响不大,但仍会出现心泵功能下降。

Objective To observe the hemodynamics during lung transplantation without cardiopulmonary bypass, when the donor lung was implantated and local heart cooling was performed. Methods Twenty-six patients with end-stage lung disease, undergone single or bilateral sequential lung transplantation with tracheal intubation general anesthesia. During the first lung transplantation, the temperature of esophagus（TE） and of blood（TB）, the hemodynamic dates such as PAP, PCWP, CCO, CI, SVI were recorded at sick lung resection（T0）, 30 minutes after the beginning of lung implantation（T1）, and 30 minutes after T1 （T2）. Results Compared with T0,TE and TB decreased at T1（P〈0.05） and at T2（P 〈 0.05）. CO and CI decreased significantly at T1 and T2 compared with T0（P 〈 0.05）. Conclusion During the implantation of lung transplantation, in the status of one-lung ventilation, ordinary temperature all over the body but heart cooling, even though have administrated with incubation and vasoactive drug, hemodynamic dates seem stable, but cardiac pump function is decrease.