FloTrac/Vigileo系统用于冠状动脉搭桥术中血流动力学监测

摘要

Objective:To observe the feasibility of FloTrac/Vigileo system for cardiac output measurement and to evaluate the associativity of monitoring results between FloTrac/Vigileo system compared and pulmonary artery catheter (PAC) for cardiac output measurement in patients undergoing off-pump coronary atery bypass grafting (OPCABG). Methods: Fifty patients undergoing off-pump coronary artery bypass grafting were cruited randomly. All patients accepted cardiac output monitiring by PAC and APCO FloTrac/Vigileo system at the same time. Following data were designed to be monitored including continuous cardiac output(CCO) .cardiac index (CI) and other hemodynamic parameters at 5 points: after anaesthesia induction ( T1) , anastomosis of left internal mammary artery to left anterior descending artery (T2) , left circumflex anastomosis(T3) .posterior descending artery anastomosis (T4) .after sternal closure(T5). Results; Correlation index of both monitoring methods of CCO measurements were 0. 70,0. 59,0. 78,0. 74 and 0. 85 at each time point. The bias range of CI difference were (0.39 ±0.06) L·min-1·m-2, (0.48 ±0.12) L·min-1·m-2, (0.26 ±0.06) L·min-1·m-2,(0.27±0.06) L·min-1·m-2 and (0. 30 ±0. 05) L·min-1·m-2 at each time point. The variation trend of SVR and CO derived from both methods were oppsite when different coronary artery anastomosis.Conclusion: APCO reflects timely,accurate and continuous hemodynamic changes in patients undergoing OP-CABG. The monitoring results derived from APCO FloTrac/Vigileo system and PAC are well correlated in patients undergoing OPCABG.%目的:观察FloTrac/Vigileo系统在非体外循环冠状动脉旁路移植术(OPCABG)血流动力学监测中应用的可行性,分析其与肺动脉导管(PAC)心排量监测(CCO)结果的相关性.方法:随机选择50例择期OPCABG的患者,所有患者同时应用连续心排出量(APCO)和CCO进行心排量(CO)监测,分别在切皮前、吻合左冠状动前降支、吻合回旋支、吻合后降支、关胸后5个时间点,测定2种方法监测的CO、心排指数(CI)及其他血流动力学参数.结果:术中在固定器放置、改变心脏位置、血管活性药物及使用正性肌力药情况下,APCO监测结果均有所改变,变化趋势与PAC监测结果一致.2种监测方法在各时间点监测的CO值的相关系数(r)分别为0.70,0.59,0.78,0.74及0.85,各时间点CI差值的偏倚范围分别为:(0.39±0.06) L·min-1 ·m-2、(0.48 ±0.12)L·min-1·m-2、(0.26±0.06)L·min-1·m-2、(0.27±0.06)L·min -1·m-2及(0.30±0.05)L·min-1 ·m-2,提示2种方法监测结果有较好的相关性.2种监测方法所得(SVR)在吻合血管时变化趋势与各自监测所得CO变化趋势相反.结论:APCO用于OPCABG术中连续CO监测具有可行性,与PAC监测法所得CO结果相关,监测结果体现了较好的即时性和动态性.