术前容量治疗对微创冠状动脉搭桥患者微血管反应性的影响

Effect of preoperative fluid therapy on microvascular reactivity in patients with minimally invasive coronary artery bypass

目的探讨术前容量治疗对微创冠状动脉搭桥(MIDCAB)患者微血管反应性的影响。方法选择择期行MIDCAB患者82例,男57例,女25例,年龄≥18岁,BMI 15~31 kg/m^(2),ASAⅢ级,NYHA分级Ⅰ或Ⅱ级。采用随机序列号法将患者分为两组:容量治疗组(T组)和对照组(C组),每组41例。T组麻醉诱导前根据被动抬腿试验,以ΔSV≥16%为目标进行术前容量治疗;C组术前不进行容量治疗。记录麻醉诱导前30 min、麻醉诱导后30 min的组织氧饱和度(StO_(2))、组织氧恢复时间(tM)、组织氧恢复斜率(RecStO_(2))、组织氧下降斜率(DesStO_(2))、SBP、DBP、MAP、Hb、静脉血氧饱和度(SvO_(2))、动脉血氧饱和度(SaO_(2))、动脉血氧含量(CaO_(2))、静脉血氧含量(CvO_(2))、氧摄取率(OER)、pH和Lac。结果与麻醉诱导前30 min比较,麻醉诱导后30 min T组MaxStO_(2)和MinStO_(2)明显升高,tM明显缩短,DesStO_(2)明显降低(P<0.05);C组MaxStO_(2)和MinStO_(2)明显升高,tM明显延长,RecStO_(2)和DesStO_(2)明显降低(P<0.05)。麻醉诱导前后30 min两组BaseStO_(2)差异无统计学意义。与C组比较,麻醉诱导后30 min T组tM明显缩短,RecStO_(2)明显升高,SBP、DBP、MAP明显升高,Lac明显降低(P<0.05)。结论基于被动抬腿试验的术前容量治疗可改善麻醉诱导后微创冠状动脉搭桥患者微血管反应性。

Objective To analyze theeffect of preoperative fluid therapy on microvascular reactivity in patients with minimally invasive direct coronary artery bypass(MIDCAB).Methods Eighty-two patients with MIDCAB,57 males and 25 females,aged≥18 years,BMI 15-31 kg/m^(2),ASA phycsical statusⅢ,NYHAⅠ-Ⅱ,were randomly divided into two groups:fluid therapy group(group T)and control group(group C),41 patients in each group.Preoperative volume therapy was performed according to the test of passive leg-raising withΔSV≥16%as the target in group T.No volume therapy was performed before anesthesia in group C.The values of SBP,DBP,MAP,tissue oxygen saturation(StO_(2)),tissue oxygen recovery time(tM),StO_(2)recovery slope(RecStO_(2)),StO_(2)decline slope(DesStO_(2)),Hb,venous oxygen saturation(SvO_(2)),arterial oxygen saturation(SaO_(2)),arterial oxygen content(CaO_(2)),venous oxygen content(CvO_(2)),oxygen extraction ratio(OER),pH,and Lac were recorded 30 minutes before and after anesthesia induction.Results Compared with 30 minutes before anesthesia induction,MaxStO_(2)and MinStO_(2)were significantly increased,tM was significantly shortened,and DesStO_(2)was significantly decreased 30 minutes after anesthesia induction in group T(P<0.05),MaxStO_(2)and MinStO_(2)were significantly increased,tM was significantly prolonged,RecStO_(2)and DesStO_(2)were significantly decreased 30 minutes after anesthesia induction in group C(P<0.05).There was no significant difference in BaseStO_(2)between the two groups 30 minutes before and after anesthesia induction.Compared with group C,tM was significantly shortened,RecStO_(2),SBP,DBP,and MAP were significantly increased,Lac was significantly decreased in group T(P<0.05).Conclusion Preoperative volume therapy based on the passive leg-raising test improved microvascular reactivity in patients with minimally invasive direct coronary artery bypass.