全身热疗对血流动力学的影响

Effects of whole-body hyperthermia on hemodynamics

目的 探讨全身热疗期间患者血流动力学的变化 ,寻找该类患者血流动力学的生理极限。方法 静吸复合全麻下 15例晚期肿瘤全身热疗患者 ,经右颈内静脉穿刺放入Swan -Ganz漂浮导管 ,经桡动脉置入动脉套管 ,两者通过换能器连Datex·OhmedaAS/ 3监护仪 ,监测血流动力学参数。结果 随着体温升高HR ,CO ,RPP ,CVP ,MPAP ,PCWP及RVSWI均逐渐升高 (P <0 0 1) ,MAP ,SVRI ,PVRI及LVSWI随着体温升高进行性下降 (P <0 0 1) ;降温过程各项指标逐渐恢复至术前水平。结论 围全身热疗期血流动力学参数变化很大 ,关键在于术中保护好各重要脏器功能 ,维持血容量、水电解质平衡、保证氧供 。

Objective To study whole-body hyperthermia (WBH) on hemodynamics and to determine the physiologocal limits. Methods\ Fifteen advanced cancer patients received WBH under general anesthesia of intravenous absorption. Swan-Ganz catheter was placed through right internal jugnlar vein and the arterial catheter was placed through radial artery. Both were connected to Datex·Ohmeda AS/3 monitor with a transducer to monitor hemodynamic parameters. Results Body temperature increased, HR, CO, RPP, CVP, MPAP, PCWP and RVSWI increased ( P <0 01) while MAP, SVRI, PVRI and LVSWI decreased progressively (P <0 01). There parameters gradually recovered to pre-operative level as temperature decreased. Conclusion Hemodynamic parameters changes greatly during the whole-body hyperthermia. The key point is to maintain blood flow to vital organs and the balance of water electrolytes and oxygen supply. The whole-body hyperthermia is a safe therapy.