FloTrac/Vigileo心排量监测在心功能不全患者非心脏手术麻醉中的应用

The application of Flo Trac / Vigileo cardiac output monitoring system in patients with cardiac dysfunction during non- cardiac operation anaesthesia

目的评价FloTrac/Vigileo心排量监测在心功能不全患者行非心脏手术麻醉中应用的安全性和可靠性。方法选择2014年8月至2015年11月入院术前存在心功能不全（心功能Ⅲ-Ⅳ级）的患者60例,ASA为Ⅱ~Ⅲ级。随机分成D组（MAP、CVP监测组）和F组（FloTrac/Vigileo监测组）,每组患者30例。麻醉诱导前两组均静脉滴注乳酸钠林格氏液（5~7ml/kg）补充补偿性扩容量;术中两组补液均静脉滴注乳酸钠林格氏液及羟乙基淀粉：D组根据CVP、MAP监测结果进行补液治疗,当CVP〈5、MAP〈65时,快速输注羟乙基淀粉至CVP〉5时停止;F组则根据SVV、CI监测结果进行目标导向液体治疗,当CI〈2.5、SVV〉13时,快速输注羟乙基淀粉至SVV〈13时停止。记录两组患者经心脏彩超检查术前2小时和术后2小时两个时间点左心室射血分数（LVEF）;记录术中输注晶体液和胶体液总量、尿量;记录入室10 min（T1）、麻醉诱导后（T2）、手术开始即刻（T3）、手术开始1 h（T4）、手术开始后2 h（T5）、手术结束出室前（T6）HR、MAP、CVP、SVV的变化以及术中不良反应发生情况。结果两组患者麻醉诱导时MAP和CVP均有下降,与D组相比较,F组MAP及CVP恢复较快,至手术开始时已接近入室水平,差异有统计学意义（P〈0.05）。与D组比较,F组手术后2小时左心室射血分数（LVEF）增加明显,差异有统计学意义（P〈0.05）。结论 FloTrac/Vigileo心排量监测能够提高心功能不全患者的左心室射血分数（LVEF）,保证组织灌注,在手术过程中为该类病患人群提供平稳的血流动力学保障。

Objective The aim was to evaluate the security and reliability of FloTrac/Vigileo cardiac output monitoring system for inpatients with cardiac dysfunction during noncardiac operation anaesthesia. Methods 60 inpatient with cardiac dysfunction （heart function between grade Ⅲ and grade Ⅳ ） before they hospitalized for operation during August 2014 and November 2015, with their ASA Level from Ⅱ to Ⅲ, were selected. They were randomly divided into group D （ MAP ＆ CVP monitoring group） and group F （ FloTrac/ Vigileo monitoring group）, 30 cases in each group. All patients were supplied with Lactated Ringer＇s solution （5 -Tml/kg） in order to expand compensatory intravascular volume before anaesthesia. In operation, the inpatients of Group D received liquid dropping infusion treatment according to the results of CVP and MAP, when CVP〈 5cmH20, MAP〈65mmHg Hydroxyethyl starch will be injected rapidly until the CVP〉ScmH20. The inpatients of Group F received goal-directed fluid therapy according to the results of SVV and CI. When CI〈2.5 and SVV〉 13, Hydroxyethyl starch will be injected rapidly, stop injecting when SVV〈 13. Record left ventricular ejection fraction （LVEF） of the inpatients those who had cardiac color ultrasonic examinations 2 hours before operation and 2 hours after the operation. Record the total volume of crystalloid solution and colloid solution and the intraoperative urine volume. Record the variations of HR, MAP, CVP and SVV of the inpatients at the following time points： 10 minutes after being put into the operation room （T1）, after anesthesia induction （3＂2）, at the beginning of the operation （T3）, 1 hour after the beginning of the operation （1＂4）, 2 hours after the beginning of the operation （ ＇1＂5）, and the time after the operation （T6）. Record the adverse reactions in operation. And make the statistical analysis of all the datas above. Results The Value of MAP and CVP of these two groups decreased after anesthesia induction. Compared with MAP and CAP of Group D, those of Group F recovered more rapidly. The volume of MAP and CVP approximated to that of the inpatients after being put into the operation room. Compared with Group D, LVEF of Group F had obvious increase 2 hours after operation. The variance has statistical significance （P〈 0. 05）. Conclusions FloTrac/Vigileo cardiac output monitoring system can increase the left ventricular ejection fraction of the inpatients with cardiac dysfunction, and it can guarantee tissue infusion, thus providing the stable and reliable basis for hemodynamics during operation.