LVETc与每搏输出量变异度在非体外循环冠脉搭桥术围术期容量管理中的应用价值

Application of Corrected Left Ventricular Ejection Time and Stroke Volume Variability in Perioperative Volume Management Guiding Off-pump Coronary Artery bypass Grafting

【目的】观察校正左心室射血时间(LVETc)与每搏输出量变异度(SVV)在指导非体外循环冠脉搭桥术(OPCABG)围术期容量管理中的应用价值。【方法】选取本院收治的择期行OPCABG术治疗的66例患者,根据随机数表法将其分为观察组与对照组,每组33例。观察组以LVETc行容量管理指导,对照组以SVV行容量管理指导,记录两组患者在手术围术期的基本指标(手术时间、总补液量、术中尿量、术中失血量、拔管时间)、不同时点血流动力学指标(平均动脉压、每搏输出量指数、心率、心指数、体循环血管阻力)、不同时点氧动力学指标(氧供指数、氧耗指数、氧摄取率),并比较两组不良反应发生情况。【结果】观察组患者总补液量显著低于对照组(P<0.05);观察组患者在心包打开(T_(0))时心率显著低于对照组(P<0.05);观察组患者在T_(0)和左前降支搭桥(T_(1))时心指数显著低于对照组(P<0.05);观察组患者在T_(0)、T_(1)、钝缘支搭桥(T_(2))及后降支搭桥(T_(3))时的体循环血管阻力显著高于对照组(P<0.05)。观察组患者氧供指数在T_(1)、T_(2)和T_(3)时均显著低于同时点的对照组(P<0.05);观察组患者氧摄取率在T_(1)、T_(2)和T_(3)时均显著高于同时点的对照组(P<0.05)。两组患者术后心血管不良事件发生情况比较,差异无统计学意义(P>0.05)。【结论】以LVETc为容量管理指导可减少总补液量,较好改善患者的血动力学及氧动力学指标,值得临床推广。

【Objective】To explore the application value of corrected left ventricular ejection time(LVETc)and stroke volume variability(SVV)in perioperative volume management guidance of off-pump coronary artery bypass grafting(OPCABG).【Methods】A total of 66 patients with OPCABG were randomly divided into the observer group and the control group,with 33 cases in each group.The volume management was guided by LVETc in the observation group,and it was guided by SVV in the control group.The basic indexes(operation time,total rehydration volume,intraoperative urine volume,intraoperative blood loss,extubation time)of the two groups during the perioperative period were recorded.The hemodynamic indexes at different time points(mean arterial pressure,stroke volume index,heart rate,cardiac index,systemic vascular resistance)and oxygen kinetic indexes at different time points(oxygen supply index,oxygen consumption index,oxygen uptake rate)were measured in the two groups.In addition,the adverse reactions of the two groups were compared as well.【Results】The total rehydra-tion volume in the observation group was significantly lower than that that in the control group(P<0.05).The heart rate of the observation group was significantly lower than that of the control group when the pericardium was opened(T_(0))(P<0.05).The cardiac index of the observation group at T_(0)and T_(1)(left anterior descending branch bypass),was significantly lower than that of the control group(P<0.05).The systemic vascular resistance of the obvServation group at T_(0),T_(1),T_(2)(blunt edge branch bypass)and T3(posterior descending branch bypass)was significantly higher than that of the control group(P<0.05).The oxygen supply index of the observation group was significantly lower than that of the control group at T_(1),T_(2) and T_(3)(P<0.05).The oxygen uptake rate of the observation group was significantly higher than that of the control group at T_(1),T_(2) and T_(3)(P<0.05).The difference was not statistically significant in comparison of postoperative cardiovascular adverse reactions between the two groups(P〉0.05).【Conclusion】Taking LVETc as the guidance of volume management can reduce the total rehy dration volume,improve the hemodynamics and oxygen kinetic indexes of patients.It reduces the fluid load in tissue space which is worthy of clinical promotion.