FloTrac/Vigileo_(V3.0)系统在肝移植手术中的应用

Usage of cardiac output measurements of FloTrac/Vigileo_(V3.0) in patients undergoing liver transplantation

目的比较FloTrac/VigileoV3.0系统监测心排血量（APCO）在肝移植手术中与SwanGanz漂浮导管经肺动脉连续心排血量（PCCO）的一致性,探讨其在肝移植手术中应用的可行性和指导术中容量治疗的临床意义。方法随机选择肝移植手术患者30例,所有患者均同时分别应用APCO和PCCO连续监测心排血量,并于麻醉后2h（T1）、无肝期前（T2）、无肝期2min（T3）、无肝期35min（T4）、新肝期2min（T5）、新肝期30min（T6）、新肝期2h（T7）及术毕（T8）,记录患者的心排量（CO）、周围血管阻力（SVR）、每搏量变异（SVV）等血流动力学参数。Bland-Altman分析法综合分析两种方法监测结果的一致性。结果与T1时比较,T2～T5时SVV明显升高,T6时SVV明显降低;T2、T3、T6～T8时PCCO明显升高,T4、T5时明显降低;T2、T5～T8时APCO明显升高,T3、T4时明显降低（P〈0.05或P〈0.01）。T1～T4、T6～T8时PCCO均明显高于APCO,T5时明显低于APCO（P〈0.05或P〈0.01）。除T3和T5时点外,APCO与PCCO的变化趋势一致,二者的一致性较好。结论 FloTrac/VigileoV3.0监测系统与Swan-Ganz漂浮导管经肺动脉连续心排血量监测的监测结果之间有较好的一致性,用于肝移植手术中连续监测CO具有可行性,可以用于指导容量治疗。

Objective The aim of this study was to assess and compare the agreement of cardiac output（CO）obtained by FloTrac/VigileoV3.0and by continuous cardiac output monitoring using pulmonary artery catheter（PAC）,to evaluate the feasibility of FloTrac/VigileoV3.0using in liver transplantation（LT）,and to approach the clinical usage of FloTrac/Vigileo for volume treatment.Methods Thirty patients undergoing LT were selected randomly.All patients accepted cardiac output monitoring by arterial pressure waveform cardiac output（APCO）and PAC at the same time.The following data,including cardiac output,stroke volume variation and other hemodynamic parameters,were recorded at eight time points：2hafter anaesthesia induction（T1）,before unhepatic stage（T2）,2min after unhepatic stage（T3）,35 min after unhepatic stage（T4）,2 min after neohepatic stage（T5）,30 min after neohepatic stage（T6）,2hafter neohepatic stage（T7）and end of operation（T8）.Statistical analysis was performed among the related parameters.Results Compared with T1,SVV at T2-T5 were significantly increased and decreased at T6;PCCO at T2,T3、T6-T8 were significantly increased and decreased at T4,T5;APCO at T2,T5-T8 were significantly increased and decreased at T3,T4（P〈0.05 or P〈0.01）.PCCO were higher than APCO at T1-T4,T6-T8 and lower at T5（P〈0.05 or P〈0.01）.Except for the time points of T3 and T5,the variation of hemodynamic parameters derived from the two methods showed a similar tendency and a well agreement.Conclusion The monitoring results derived from FloTrac/VigileoV3.0system are in accordance with PAC in patients undergoing liver transplantation.It is feasible to reflect CO changes monitored by FloTrac/VigileoV3.0system and to guide volume treatment.