|
摘要：
目的 探讨在肺移植手术麻醉中CVP、舒张末期容积指数（global end‑diastolic volume index, GEDI）、胸腔血容积指数（intrathoracic blood volume index, ITBI）与心脏指数（cardiac index, CI）的相关性，为临床应用提供参考。 方法 选择行肺移植手术的终末期肺病患者22例，麻醉诱导完成后于左侧股动脉穿刺置入脉搏指示连续心排血量（pulse index continuous cardiac output, PiCCO）专用带温度探头的压力监测管并连接监护仪，右颈内静脉或锁骨下静脉穿刺放置中心静脉导管监测CVP，同时右侧颈内静脉放置连续温度稀释Swan‑Ganz导管，连续监测肺动脉压（pulmonary arterial pressure, PAP）、CI、GEDI及ITBI。分别记录麻醉后5 min双肺通气时（T0）、手术开始后20 min单肺通气时（T1）、肺动脉阻断10 min时（T2）、肺动脉开放后20 min时（T3）、恢复双肺通气20 min后（T4）和手术结束平卧位10 min后（T5）的MAP、心率、PAP、CVP、CI、GEDI 及ITBI。对CVP、GEDI 、ITBI与CI行相关性分析。 结果 各时间点的MAP和心率差异无统计学意义（P>0.05）；与T0时点比较，T3、T4、T5时点PAP明显降低（P<0.05），T2时点PAP明显高于其他各时点（P<0.05）；T1、T2时点CVP明显高于其他时点（P<0.05）；T2时点CI与其他时间点比较明显降低（P<0.05）；T2时点GEDI及ITBL较T0、T3明显降低（P<0.05）；其他各时点之间CVP、CI、GEDI及ITBL差异无统计学意义（P>0.05）；T0、T4及T5时点，CVP与CI呈正相关（P<0.05）；T0~T5时点，GEDI、ITBI与CI呈正相关（P<0.05） 结论 在肺移植手术麻醉中，GEDI、ITBI与CI的相关性优于CVP。
|
|
Abstract: Objective To evaluate the association of central venous pressure (CVP), global end‑diastolic volume index (GEDI), and intrathoracic blood volume index (ITBI) with cardiac index (CI) during anesthesia for lung transplantation, so as to provide reference for clinical application. Methods A total of 22 patients with end‑stage lung disease who underwent lung transplantation were enrolled. After anesthesia induction, all the patients were inserted with pulse index continuous cardiac output (PiCCO) catheter in the left femoral artery and connected with a monitor. Central venous catheters were inserted within the right internal jugular vein or subclavian vein to monitor CVP. Meanwhile, Swan‑Ganz catheters were inserted into the right internal jugular vein. Their pulmonary arterial pressure (PAP), CI, GEDI and ITBI were continuously monitored. Then, their mean arterial pressure (MAP), heart rate, PAP, CVP, CI, GEDI and ITBI were recorded during two‑lung ventilation 5 min after anesthesia (T0), during one‑lung ventilation 20 min after operation (T1), when the pulmonary artery was clamped (T2), 20 min after the pulmonary artery was opened (T3), when two‑lung ventilation was recovered for 20 min (T4) and in the supine position for 10 min after operation (T5). The association of CVP, GEDI, ITBI with CI was analyzed. Results There was no statistical difference in MAP and heart rate among each time point (P>0.05). Compared with those at T0, remarkable decreases were found in PAP at T3, T4 and T5 (P<0.05), where PAP was obviously higher at T2 than those at other time points (P<0.05). CVP was obviously higher at T1 and T2 than those at other time points (P<0.05). CI at T2 significantly decreased compared with those at othertime points (P<0.05). GEDI and ITBL at T2 were significantly higher than those at T0 and T3 (P<0.05). There was no statistical difference in CVP, CI, GEDI and ITBL among other time points (P>0.05). There was a positive correlation between CVP and CI at T0, T4 and T5 (P<0.05). There was a positive correlation among GEDI, ITBI and CI at T0 to T5 (P<0.05). Conclusions The correlations of GEDI and ITBI with CI are better than CVP during the anesthesia of lung transplantation.
|
