非体外循环冠状动脉搭桥术患者术中实施目标导向容量治疗的临床研究

Perioperative goal -directed capacity during off- pump coronary artery bypass surgery

目的探讨基于经食道超声心动图（TEE）和Violeo／微截流（FloTrac）技术任实施L1标导阳的容量治疗在非体外循环冠状动脉搭桥术中的应用。方法纳入81例行择期实施非体外循环冠脉搭桥手术的冠心病患者，随机分为2组：每搏变异度（SVV）结合TEE组41例，对照组40例，实验组患者围术期及ICU24h采用目标导向容量治疗，即在SVV、TEE等指标下进行个体化容量治疗；时照组根据传统容量治疗方法。比较围术期及术后3d统计液体补充的种类和量、出血量，乳酸禽请，氧含量、住院时间、术后心脏不良事件及并发症的发生率。结果与对照组比较，实验组患者手术过程巾血流动力学更加平稳。手术结束时实验组患者血清乳酸含量[（0．28±0．03）mmol／L]明显低于对照组[（2．21±0．12）mmol／L，P〈0．05]。实验组患者总输液量[（2912±632）ml和（3641±723）ml]、品体使用量均明显少于对照组[（1543±331）ml和（2334±323）m1]，而胶体使用量则明艟多于对照组[（1012±221）ml和（797±249）ml，P〈0．05]。实验组患者围术期住院时间分别为（17±4）和（27±7）d（P〈0．05），ICU停留时间分别为（38±13）h和（54±22）h（P〈0．05）。结论磁心病患者实施实施非体外循环冠脉搭桥手术期间，目标导向容量治疗可明显减少各类心脏小良书件的发生率，改善术后心脏功能并缩短住院时间，其容量的治疗效应优于常规容量治疗，

Objective Evaluate the extracorporeal circulation of coronary artery bypass graining （t）PCABG） intraopcrativc hemodynamic changes, based on the classics esophagus supersonic and Violeo FloTrae/technical implementation capacity of goal - directed therapy, trying to provide reference for indi- vidualized treatment capacity. Methods included 81 names of routine execution of extracorporcal eirculation of coronary artery bypass surgery in patients with coronary heart disease, were randomly divided into 2 groups： stroke volume variation （SVV） , transesophageal echocardiography （TEE） group 41 cases, 40 cases in the control group, experimental group patients and perioperative treatment with ICU24h goal - directed capacity, namely the SVV stroke variation degree, individualized treatment capacity under TEE index; Control the amount of fluids is calculated according to the traditional law of 4/2/1. Comparison of perioper- atiw and postoperative 3 days statistical amount and type of liquid supplement, blood loss, and urine out- pat, lactic acid content, oxygen content, record the cxtubation time, ICU stay time, length of hospital stay, postoperative cardiac adverse events and the inciden. Results Compared with control group, test group patients in the operation process, more stable blood stream dynamics. At the end of operation in the test group serum lactic acid content was lower than that of control group [ （ 0. 28± 0.03 ） mmol/L vs. （ 2. 21 ± 0. 12 ） mmol/L）, P 〈 0. 05 ]. In the test group total infusion volume [ （ 2 912 ± 632 ） ml vs. （3 641±723）ml, the use of crystal were significantly less than the control group [ （1 543 ±331 ） ml vs. （2 334 ±323） ml], and the colloid use amount is much more than that in control group [ （ 1 012± 221 ） ml vs. （797 ±249） nil, P 〈0. 05]. The test group patients hospital stay and ICU stay were lower than the control group [（17±4） dvs. （27 ±7） d,P〈0.05, （38±13） hvs. （54 ±22） h, P〉0.05]. Conclusion The patients with coronary heart disease （CHD） implementation of the implementation of extracorporcal circulation during coronary artery bypass graft surgery, capacity of goal - directed therapy can obviously reduce the incidence of all kinds of adverse cardiac events, improve heart function and shorten the length of hospital stay, postoperative treatment effect of its capacity is superior to the conventional treatment capacity.