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血管超声用于评价OPCABG麻醉诱导期琥珀酰明胶行急性容量填充对外周灌注影响的对照研究
A COMPARATIVE STUDY ON THE EFFECT OF GELOFUSINE ON USING ULTRASOUND TO EVALUATE PERIPHERAL PERFUSION DURING OPCABG

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DOI:
作者:
董榕
DONG Rong, FAN Youjia, YU Buwei
作者单位:
上海交通大学医学院附属瑞金医院麻醉科
Department of Anesthesiology,Shanghai Shanghai 200025,China
关键词:
容量填充，非体外循环下冠状动脉搭桥术，血管多普勒超声，Swan-Ganz导管，外周灌注
hypervolemic hemodilution, off-pump coronary artery bypass graft, vascular Doppler ultrasound, Swan-Ganz catheter
摘要:
【摘要】目的 通过血管超声的方法测定桡动脉血流，比较非体外循环下行冠状动脉搭桥术(off-pump coronary artery bypass graft, OPCABG)患者麻醉诱导期以琥珀酰明胶注射液(佳乐施，Gel，500ml，沈阳贝朗制药有限公司，批号：9081Q47)行急性高容量填充与不做填充对患者外周血管灌注和术后恢复情况的影响。方法 将30例行择期OPCABG患者随机分为两组，全麻诱导后组Ⅰ不填充，组Ⅱ则于手术前输注0.4ml/kg/min的Gel，通过Swan-Ganz导管监测心指数(Cardiac Index, CI)变化，至CI进入平台期即停止输注。记录入室（T1）、镇静后（T2）、诱导后开始填充（T3）、填充结束手术切皮时（T4）、搭前降支远端（T5）、搭边缘支时（T6）、心脏处于直立位搭后降支时（T7）、桥血管开放心脏恢复正常位置时（T8）及术毕（T9）各时间点的桡动脉直径和流量，记录T4~T8各点Swan-Ganz的数据。结果 两组各时间点桡动脉直径均无组间差异。镇静后，两组桡动脉流量均较基础值有不同程度的增加。T3~T8桡动脉血流量组Ⅱ高于组Ⅰ(P<0.05)， T5~T8CI值组Ⅱ均高于组Ⅰ (P<0.05)，T8CVP值组Ⅱ高于组Ⅰ (P<0.05)，术中苯肾的用量组Ⅰ高于组Ⅱ(P<0.01)。 术后拔管时间及ICU停留时间组Ⅱ均短于组Ⅰ(P<0.05)，差异均有统计学意义。结论 OPCABG患者，麻醉期诱导期以CI反馈行容量填充不仅增加了有效循环容量和心排血量，同时可改善外周桡动脉灌注，有利于“快通道”的实施和患者术后的恢复。
ABSTRACT Background and Objectives: The aim of this study was designed to compare hypervolemic infusion using succinylated gelatin and none volume expansion on peripheral vascular perfusion which was evaluated by vascular Doppler ultrasound during off-pump coronary artery bypass graft (OPCABG). The Swan-Ganz monitoring was used to guide hypervolemic infusion during the period of anesthetic induction. Data from Swan-Ganz were also compared between two groups. Methods: Thirty patients undergoing elective off-pump coronary artery bypass graft were randomly assigned into 2 groups. GroupⅠ (n=15): no succinylated gelatin injection was infused within 30 minutes before the incision. Group Ⅱ (n=15): 0.4ml/kg/min of succinylated gelatin injection was infused each minute until cardiac index (CI) was achieved the steady state. The Swan-Ganz monitoring was used to evaluate patients’ circulatory function and to guide the Gel infusion. Meantime the diameter and flow of radial artery were measured by vascular Doppler ultrasound. These data were record on baseline(T1)、after sedation(T2)、after intubation(T3)、the end of volume expansion(T4)、grafting LAD(T5)、grafting OM(T6)、grafting PDA(T7)、all the grafts have been opened(T8) and the end of surgery(T9). Results: There was no difference between two groups in diameter of the radial artery. After sedation the flow of radial artery increased significantly in either group (P<0.05). The flow of radial artery in groupⅡwas much higher than that in groupⅠ on T3~T8. CI was higher in groupⅡ than that in groupⅠ on T5~T8 (P<0.05). CVP was higher in groupⅡ than that in groupⅠ on T8. The dosage of phenylepgrine in groupⅠ was higher than that in groupⅡ. Either the time of tracheal extubation or ICU stay was significantly shorter in group Ⅱ than that in groupⅠ (P<0.05). Conclusions: Adequate volume expansion with succinylated gelatin injection after anesthetic induction is beneficial to the cardiac insufficiency patients who are undergoing OPCABG. This strategy can not only increase patients’ cardiac output and peripheral blood flow but also shorten the time to tracheal tube removal and ICU stay. Thus it is beneficial to “fast tract” and patients’ outcome.

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