膨肺对不停跳冠脉搭桥患者血流动力学的影响

The Effects of Lung Expansion on the Hemodynamics in Patient with Off-Pump Coronary Artery Bypass Grafting

目的:探讨膨肺对不停跳冠脉搭桥患者过肺静脉和二尖瓣血流及血压的影响。方法:择期全麻下行冠脉搭桥患者30例,年龄55~70岁,ASA II~III级。所有患者均于麻醉诱导后常规放置经食道心脏超声探头。然后根据搭桥过程中心脏所处的位置分为:心脏正常位(Nor)、前降支位(Ant)、回旋支位(Cir)和后降支位(Pos),所有患者均在心脏的不同位置时采用超声的连续多普勒技术评价膨肺前后肺静脉血流和过二尖瓣血流的变化,同时记录不同心脏位置时二、三尖瓣的反流与膨肺前后平均动脉压的变化情况。结果:1) 相比较于Nor,Cir和Pos单位时间内通过肺静脉血流明显减少(P 【0.01);但膨肺仅使Cir位的肺静脉血流增加(P 【0.01);2) 相比较于Nor,Ant、Cir和Pos位通过二尖瓣的血流均减少,同样膨肺增加了Cir位时通过二尖瓣的血流(P 【0.01);3) 相比较于膨肺前,膨肺后仅Cir组MAP升高有统计学意义(P 【0.05)。结论:不停跳冠状动脉搭桥的操作会使通过肺静脉或二尖瓣的血流减少,膨肺能够增加搭回旋支时通过肺静脉及二尖瓣的血流,升高血压。

Objective: To investigate the effect of lung expansion on the blood flow through pulmonary vein and mitral in patients with off-pump coronary artery bypass grafting (OPCABG). Methods: Thirty patients undergoing coronary artery bypass under elective general anesthesia, aged 55~70 years old, grade ASA II~III were involved. All patients were placed with transesophageal cardiac ultrasound probe routinely after induction of anesthesia. Data were got from the different positions of the heart: normal heart position (Nor), anterior descending branch position (Ant), circumflex branch position (Cir) and posterior descending branch position (Pos). All patients were evaluated the changes of blood flow through pulmonary venous and mitral valve before and after lung expansion at different locations of the heart by using continuous Doppler, and the changes in mean arterial pressure were also recorded. Results: 1) Compared with the Nor, the blood flow through pulmonary vein was reduced following the position alternation, especially in Cir and Pos (P