目的通过脉波指示连续心排量监测(pulse-indicated continuous cardiac output，PiCCO)监测老年患者不停跳(off-pump)冠状动脉旁路移植(coronary artery bypass grafting，CABG)术中血流动力学变化。方法经筛选的本院老年冠状动脉硬化性心脏病30例在不停跳下行冠状动脉旁路移植术。应用PiCCO监测动脉压(ABP)、心率(HR)、中心静脉压(CVP)、心输出量指数(CO)、心脏指数(CI)、全心射血分数(GEF)、每搏量指数(SVI)、胸腔内血容量指数(ITBI)、全心舒张末期容量指数(GEDVI)等指标。分别记录手术前(T0)、乳内动脉(LIMA)-前降支(LAD)吻合后(T1)、全部血管吻合后(T2)、术后2 h(T3)、术后24 h (T4)的数据。结果30例均顺利实施手术。T0时ABP、CVP、CO、GEF和SVI较T3、T4时明显降低(P＜0.05)，T0时ABP、CO、GEF和SVI较T1时明显降低(P＜0.05)，T0时ITBI和GEDVI较T3、T4时降低，T0时CI较T3、T4时明显上升(P＜0.05)。30例均恢复顺利，无外科并发症及与PiCCO操作相关的并发症。结论 PiCCO技术简捷可靠，适合于老年患者CABG的临床应用。%Objective To monitor the hemodynamics in elderly heart disease patients during off-pump coronary artery bypass grafting (CABG) with pulse-indicated continuous cardiac output (PiCCO) system. Methods Thirty elderly patients with coronary ateroclerotic heart disease who underwent off-pump CABG were included in this study. Their ABP, HR, CVP, CO, CI, GEF, SVI, ITBI and GEDVI were measured with PiCCO system at T0, T1, T2, T3 and T4 , respectively. Results The operation was successful for all the patients. The ABP, CVP, CO, GEF and SVI were significantly lower at T0 than at T3 and T4 , and at T0 than at T1 (P<0.05). The ITBI and GEDVI were significantly lower while the CI was significantly higher at T3 and T4 than at T0 (P<0.05). The patients recovered with no surgical and PiCCO manipulation-related complications. Conclusion PiCCO system is a simple and reliable device for monitoring hemodynamics in elderly coronary disease patients during off-pump CABG.
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