基于脉搏波监测的体外循环搏动灌注效果评价研究

Effects of pulsatile perfusion during cardiopulmonary bypass procedures based on sphygmograms test

目的通过观察体外循环不同灌注模式对机体的影响,建立基于"寸口"脉搏波监测的体外循环搏动灌注有效性评价的方法。方法将52例需体外循环术治疗的心脏病患者,随机分为搏动灌注组(P组)26例和非搏动灌注组(NP组)26例;采用Power Lab8/30生理仪全程记录"寸口"脉搏波、血流量、血压和泵压;计算两组患者的脉压差(ΔP)、平均动脉压力(MAP)、能量等值压力(EEP)和富余血流动力能量(SHE);检测体外循环术前后血栓弹力图(TEG)。结果 1术前两组患者均检测到"寸口"脉搏波;体外循环术后搏动灌注组患者桡动脉均检测到"寸口"脉搏波,非搏动灌注组患者桡动脉未能检测到"寸口"脉搏波。2搏动灌注组ΔP、EEP和SHE值显著高于非搏动灌注组(P<0.001),两组MAP差异无统计学意义(P>0.05)。3搏动灌注组凝血反应时间(R)较非搏动灌注组延长(P<0.05),凝血综合指数(CI)显著低于非搏动灌注组(P<0.05)。结论体外循环搏动灌注模式在增加血流灌注压力和血流搏动能量、降低血液黏度等方面优于非搏动灌注模式;体外循环搏动灌注模式的ΔP、EEP和SHE显著高于非搏动灌注模式,提示脉搏波可以作为监测体外循环有效搏动灌注的客观指标。

Objective To establish an evaluation method of efficacy on monitoring pulsatile perfusion during cardiopulmonary bypass（ CPB） based on＂Cunkou＂sphygmogram test through monitoring effects of different types of pulsatile perfusion on body during cardiopulmonary bypass. Methods 52 patients with heart valve diseases undergoing cardiopulmonary bypass were randomized into pulsatile group（ P group,n = 26） and nonpulsatile group（ NP group,n = 26）. The ＂Cunkou＂pulse wave,pump flow rate,arterial pressure and pump pressure were recorded by Power Lab 8 /30 physiology recorder. The value of pulse pressure（ ΔP）,mean arterial pressure（ MAP）,energy equivalent pressure（ EEP） and surplus hemodynamic energy（ SHE） were calculated during CPB stabled. Thrombelastograph analyzer（ TEG） was examined. Results 1 The ＂Cunkou＂pulse waveforms could be detected in all patients before CPB. After the CPB,the ＂Cunkou＂pulse waveforms could be detected in P group but could not be detected in NP group. 2 The ΔP,EEP and SHE were significantly higher in P group than NP group（ P 0. 001）,and the MAP was no significant difference in both groups（ P 0. 05）. 3 The R level amplified longer in P group than NP group（ P 0. 05） and CI level cut shorter in TEG in P group than in NP group（ P 0. 05）. Conclusion Pulsatile perfusion during cardiopulmonary bypass was better than nonpulsatile in such aspects as increasing blood perfusion pressure,increasing blood perfusion energy and decreasing blood viscosity,etc. The ΔP,EEP and SHE were significantly higher in pulsatile perfusion during cardiopulmonary bypass than nonpulsatile. It suggested that sphygmogram can be used as an objective index on monitoring pulsatile perfusion during cardiopulmonary bypass.