Objective: To investigate the variation of functions of the heart and lung during orthotopic liver transplan- tation (OLT). Methods: Pulmonary artery cannula and right radial artery cannula were indewelled before anae...Objective: To investigate the variation of functions of the heart and lung during orthotopic liver transplan- tation (OLT). Methods: Pulmonary artery cannula and right radial artery cannula were indewelled before anaesthesia and the parameters of hemodynamics in different pe- riods were monitored. Analysis of variance was used to reveal the variation among the groups. T hypothe- sis test in paired data was used to compare the preop- erative parameters with those in each period during operation and after operation respectively, and to compare the parameters immediately after operation with those in each period after operation respective- ly. Results: During the operation, heart rate increased, but blood pressure decreased significantly at the be- ginning of no-liver period, increased again in a short period and then increased progressively 12 h after op- eration. Pulmonary artery pressure (PAP) increased from before the no-liver period to 60 h after opera- tion. Pulmonary wedge pressure changed in accord- ance with the variation of PAP. Cardiac output was maintained at a high-output level from before opera- tion to 60 h after operation. Systemic vascular resist- ance (SVR) was within the normal limits before op- eration, whereas pulmonary vascular resistance (PVR) was lower than normal. In the no-liver peri- od during the operation, SVR decreased significant- ly. Both SVR and PVR increased progressively and returned to normal postoperatively. Conclusions: The patients undergoing OLT have a high cardiac output and Iow resistance obstacle be- fore and during the operation, and will recover grad- ually after operation. Monitoring hemodynamics during the peri-operative period is of significance in the prevention and treatment of pneumonedema and cardiac functional insufficiency.展开更多
Background Right ventricular function plays an important role in the hemodynamic derangement during off-pump coronary artery bypass （OPCAB） surgery. Pressure-volume loops have been shown to provide load-independent ...Background Right ventricular function plays an important role in the hemodynamic derangement during off-pump coronary artery bypass （OPCAB） surgery. Pressure-volume loops have been shown to provide load-independent information of cardiac function. Therefore, the aim of this study was to investigate the feasibility of construction of right ventricular pressure-volume loops with pressure and volume data measured by a volumetric pulmonary artery catheter （PAC） and to evaluate right ventricular systolic and diastolic function by end-systolic elastance （EEs） and end-diastolic stiffness （EED） in OPCAB surgery. Methods Twenty-eight patients who underwent OPCAB surgery were included. After anesthesia induction, a volumetric PAC was placed via the right internal jugular vein. Data were recorded at： anesthesia steady-state before skin incision （T1）; 5 minutes after the stabilizer device was placed for anastomosis on the heart＇s anterior wall （T2）, lateral wall （T3）, posterior wall （T4）, respectively; after sternal closure （T5）. Three sets of data were collected at each time point： first, hemodynamic variables were measured; second, right ventricular EEs and EED were calculated; third, right ventricular pressure-volume loops were constructed with pressure and volume data measured from end-diastole point, end-isovolumic systole point, peak-ejection point, end-systole point and end-isovolumic diastole point. Results Right ventricular pressure-volume loops generally shifted to the left during OPCAB surgery. Especially, the end-diastolic point shifted upward and to the left at T2--T5 compared with that at T1. Decrease in right ventricular ejection fraction, stroke volume index and end-diastolic volume index occurred （P 〈0.05） at T4 compared with values at TI. Pulmonary vascular resistance index at T4 increased relatively compared with that at T2 and T3. The change of EEs was not statistically significant during operation. Right atrial pressure increased only during coronary anastomoses （T2-- T4, P 〈0.05）, whereas EED increased throughout OPCAB surgery （P 〈0.05）. Conclusions Right ventricular pressure-volume loops can be constructed using a volumetric PAC. Right ventricular systolic dysfunction occurred during anastomoses on the heart＇s posterior wall not due to impaired myocardial contractility but as a result of reduced preload and a relative increase in afterload. Right ventricular diastolic function was impaired throughout OPCAB surgery.展开更多
Background For patients undergoing off-pump coronary artery bypass grafting （OPCABG）, it is important to establish a hemodynamic monitoring system to obtain powerful parameters for better intraoperative treatment. T...Background For patients undergoing off-pump coronary artery bypass grafting （OPCABG）, it is important to establish a hemodynamic monitoring system to obtain powerful parameters for better intraoperative treatment. This study aimed to observe the clinical feasibility of arterial pressure-based cardiac output （APCO） for cardiac output （CO） monitoring and to evaluate the correlation between APCO and pulmonary artery catheter （PAC） for CO measurement for patients undergoing OPCABG intraoperatively. Methods Fifty patients of American Society of Anaesthesiologists （ASA） classification Ⅱ-Ⅲ, undergoing elective OPCABG at Beijing Anzhen Hospital were randomly enrolled into this study. All patients were assigned to CO monitoring by PAC and APCO simultaneously. Patients with pacemaker, severe valvular heart disease, left ventricular ejection fraction （EF） 〈40%, cardiac arrhythmias, peripheral vascular disease, application of intra-aortic balloon pump （IABP） and emergent diversion to cardiac pulmonary bypass were excluded. The radial artery waveform was analyzed to estimate the stroke volume （SV） and heart rate （HR） continuously. CO was calculated as SV × HR; other derived parameters were cardiac index （CI）, stroke volume index （SVI）, systemic vascular resistance （SVR）, and systemic vascular resistance index （SVRI）. PAC was placed via right internal jugular vein and the correct position was confirmed by PAC waveforms. Continuous cardiac output （CCO）, CI and other hemodynamic parameters were monitored at following 5 time points： immediate after anesthesia induction （baseline value）, anastomosis of left internal mammary artery to left anterior descending artery （LAD）, anastomosis of left circumflex （LCX）, anastomosis of posterior descending artery （PDA） and immediate after sternal closure. Results In the 50 patients, preoperative echocardiography measured left ventricular EF was （52.8±11.5）%, and 35 patients （70%） showed regional wall motion abnormalities. The correlation coefficient of CO monitored by APCO and PAC were 0.70, 0.59, 0.78, 0.74 and 0.85 at each time point. The bias range of CI monitored from both APCO and PAC were （0.39±0.06） L.minl.m2, （0.48±0.12） L.min^-1.m2, （0.26±0.06） L.min1.m-2, （0.27±0.06） L.min-l.m2, （0.30＋0.05） L.min-l.m2 at each time point. The results of SVR by two hemodynamic monitoring techniques had good correlation during OPCABG. The variation trends of SVR were opposite comparing with the results of CO. SVR collected from PAC obtained the highest value of （1220.0±254.0） dyn.s.cm5 at PDA anastomosis, but the highest value obtained from APCO was （1206.0±226.5） dyn.s.cm-5 in LCX anastomosis. Conclusions APCO is feasible in hemodynamic monitoring for patients undergoing OPCABG The results of hemodynamic monitoring derived from APCO and PAC are closely correlated. Its characterizations of timely, accurate and continuous display of hemodynamic parameters are also obviously demonstrated in the present study.展开更多
文摘Objective: To investigate the variation of functions of the heart and lung during orthotopic liver transplan- tation (OLT). Methods: Pulmonary artery cannula and right radial artery cannula were indewelled before anaesthesia and the parameters of hemodynamics in different pe- riods were monitored. Analysis of variance was used to reveal the variation among the groups. T hypothe- sis test in paired data was used to compare the preop- erative parameters with those in each period during operation and after operation respectively, and to compare the parameters immediately after operation with those in each period after operation respective- ly. Results: During the operation, heart rate increased, but blood pressure decreased significantly at the be- ginning of no-liver period, increased again in a short period and then increased progressively 12 h after op- eration. Pulmonary artery pressure (PAP) increased from before the no-liver period to 60 h after opera- tion. Pulmonary wedge pressure changed in accord- ance with the variation of PAP. Cardiac output was maintained at a high-output level from before opera- tion to 60 h after operation. Systemic vascular resist- ance (SVR) was within the normal limits before op- eration, whereas pulmonary vascular resistance (PVR) was lower than normal. In the no-liver peri- od during the operation, SVR decreased significant- ly. Both SVR and PVR increased progressively and returned to normal postoperatively. Conclusions: The patients undergoing OLT have a high cardiac output and Iow resistance obstacle be- fore and during the operation, and will recover grad- ually after operation. Monitoring hemodynamics during the peri-operative period is of significance in the prevention and treatment of pneumonedema and cardiac functional insufficiency.
文摘Background Right ventricular function plays an important role in the hemodynamic derangement during off-pump coronary artery bypass （OPCAB） surgery. Pressure-volume loops have been shown to provide load-independent information of cardiac function. Therefore, the aim of this study was to investigate the feasibility of construction of right ventricular pressure-volume loops with pressure and volume data measured by a volumetric pulmonary artery catheter （PAC） and to evaluate right ventricular systolic and diastolic function by end-systolic elastance （EEs） and end-diastolic stiffness （EED） in OPCAB surgery. Methods Twenty-eight patients who underwent OPCAB surgery were included. After anesthesia induction, a volumetric PAC was placed via the right internal jugular vein. Data were recorded at： anesthesia steady-state before skin incision （T1）; 5 minutes after the stabilizer device was placed for anastomosis on the heart＇s anterior wall （T2）, lateral wall （T3）, posterior wall （T4）, respectively; after sternal closure （T5）. Three sets of data were collected at each time point： first, hemodynamic variables were measured; second, right ventricular EEs and EED were calculated; third, right ventricular pressure-volume loops were constructed with pressure and volume data measured from end-diastole point, end-isovolumic systole point, peak-ejection point, end-systole point and end-isovolumic diastole point. Results Right ventricular pressure-volume loops generally shifted to the left during OPCAB surgery. Especially, the end-diastolic point shifted upward and to the left at T2--T5 compared with that at T1. Decrease in right ventricular ejection fraction, stroke volume index and end-diastolic volume index occurred （P 〈0.05） at T4 compared with values at TI. Pulmonary vascular resistance index at T4 increased relatively compared with that at T2 and T3. The change of EEs was not statistically significant during operation. Right atrial pressure increased only during coronary anastomoses （T2-- T4, P 〈0.05）, whereas EED increased throughout OPCAB surgery （P 〈0.05）. Conclusions Right ventricular pressure-volume loops can be constructed using a volumetric PAC. Right ventricular systolic dysfunction occurred during anastomoses on the heart＇s posterior wall not due to impaired myocardial contractility but as a result of reduced preload and a relative increase in afterload. Right ventricular diastolic function was impaired throughout OPCAB surgery.
文摘Background For patients undergoing off-pump coronary artery bypass grafting （OPCABG）, it is important to establish a hemodynamic monitoring system to obtain powerful parameters for better intraoperative treatment. This study aimed to observe the clinical feasibility of arterial pressure-based cardiac output （APCO） for cardiac output （CO） monitoring and to evaluate the correlation between APCO and pulmonary artery catheter （PAC） for CO measurement for patients undergoing OPCABG intraoperatively. Methods Fifty patients of American Society of Anaesthesiologists （ASA） classification Ⅱ-Ⅲ, undergoing elective OPCABG at Beijing Anzhen Hospital were randomly enrolled into this study. All patients were assigned to CO monitoring by PAC and APCO simultaneously. Patients with pacemaker, severe valvular heart disease, left ventricular ejection fraction （EF） 〈40%, cardiac arrhythmias, peripheral vascular disease, application of intra-aortic balloon pump （IABP） and emergent diversion to cardiac pulmonary bypass were excluded. The radial artery waveform was analyzed to estimate the stroke volume （SV） and heart rate （HR） continuously. CO was calculated as SV × HR; other derived parameters were cardiac index （CI）, stroke volume index （SVI）, systemic vascular resistance （SVR）, and systemic vascular resistance index （SVRI）. PAC was placed via right internal jugular vein and the correct position was confirmed by PAC waveforms. Continuous cardiac output （CCO）, CI and other hemodynamic parameters were monitored at following 5 time points： immediate after anesthesia induction （baseline value）, anastomosis of left internal mammary artery to left anterior descending artery （LAD）, anastomosis of left circumflex （LCX）, anastomosis of posterior descending artery （PDA） and immediate after sternal closure. Results In the 50 patients, preoperative echocardiography measured left ventricular EF was （52.8±11.5）%, and 35 patients （70%） showed regional wall motion abnormalities. The correlation coefficient of CO monitored by APCO and PAC were 0.70, 0.59, 0.78, 0.74 and 0.85 at each time point. The bias range of CI monitored from both APCO and PAC were （0.39±0.06） L.minl.m2, （0.48±0.12） L.min^-1.m2, （0.26±0.06） L.min1.m-2, （0.27±0.06） L.min-l.m2, （0.30＋0.05） L.min-l.m2 at each time point. The results of SVR by two hemodynamic monitoring techniques had good correlation during OPCABG. The variation trends of SVR were opposite comparing with the results of CO. SVR collected from PAC obtained the highest value of （1220.0±254.0） dyn.s.cm5 at PDA anastomosis, but the highest value obtained from APCO was （1206.0±226.5） dyn.s.cm-5 in LCX anastomosis. Conclusions APCO is feasible in hemodynamic monitoring for patients undergoing OPCABG The results of hemodynamic monitoring derived from APCO and PAC are closely correlated. Its characterizations of timely, accurate and continuous display of hemodynamic parameters are also obviously demonstrated in the present study.
文摘目的使用电导导管测量小鼠右心室压力-容积环,评估健康小鼠及肺动脉高压模型小鼠的血流动力学。方法将16只小鼠随机分为实验组(n=8)和对照组(n=8)。实验组小鼠暴露在常压缺氧的环境中10 d,对照组小鼠被安置在室内空气中。使用1.2 F导管从右颈动脉插至升主动脉,另外再穿刺右心室心尖部,用20号针头导入1.2 F压力-容积导管,获得压力-容积的测量值并计算血流动力学参数。比较两组小鼠血流动力学参数的差异。结果两组小鼠体重、右心房重量/体重、左心房重量/体重、(左心室+室间隔)重量/体重比较,差异均无统计学意义(均P>0.05);实验组小鼠右心室重量/(左心室+室间隔)重量[(0.30±0.03)比(0.23±0.06),P=0.0291]、右心室重量/体重[(1.04±0.13)比(0.74±0.10),P=0.0001]显著高于对照组,差异均有统计学意义。两组小鼠心率、主动脉收缩压、主动脉舒张压、右心室舒张末期容积、心室内最大压力上升速度、右心室收缩末期压力-容积关系的斜率、心室内最大压力下降速度、松弛因子τ比较,差异均无统计学意义(均P>0.05)。实验组小鼠血细胞容积率、右心室收缩压、右心室舒张压、搏出功、压力导数的最大值与右心室舒张末期压力容积关系的斜率、前负荷补充搏功、动脉有效弹性显著大于对照组,差异均有统计学意义;而射血时间[(36±2)ms比(45±1)ms,P=0.0001]、心输出量[(5.2±2.6)ml/min比(8.5±2.3)ml/min,P=0.0026]、心室顺应性[(0.43±0.13)μl/mm Hg比(0.68±0.21)μl/mm Hg,P=0.0030(1 mm Hg=0.133 k Pa)]、射血分数[(28±13)%比(51±11)%,P=0.0008]、耦合效率[(0.36±0.15)比(0.73±0.26),P=0.0001]显著低于对照组,差异亦均有统计学意义。结论本研究验证了电导导管测量小鼠右心室压力-容积数据的可能性,为健康状态或疾病状态下的右心室-肺动脉耦合机制的研究提供了方向。
