摘要
目的了解非体外循环下冠状动脉旁路移植术(OPCAB)后血管麻痹综合征(VS)的血流动力学变化。方法选择我院行OPCAB患者,均在术中放置Swan-Ganz导管,监测术后30min、2h、4h、6h、8h、12h平均动脉压(MAP)、中心静脉压(CVP)、肺毛细血管锲压(PCWP)、心排指数(CI)、体循环阻力(SVRI)、混合静脉血氧饱和度(Sv O2)。术后即刻、6h、24h、48h检测降钙素原(PCT)、C-反应蛋白(CRP),进行统计学分析。结果发生VS患者42例,发生率为4.69%。VS组MAP、SVRI术后4h、6h、8h明显降低,与术后30min相比有明显差异(P<0.05),以术后6h差异最大。MAP在术后4h、6h、8h分别与相应时间对照组相比有明显降低(P<0.05),SVRI在术后6h、8h分别与相应时间对照组相比有明显降低(P<0.05)。VS组PCWP、Sv O2在术后6h明显低于对照组(P<0.05)。VS组PCT术后6h明显高于对照组(P<0.05),且与MAP变化有明显的相关性(r=-0.492,P<0.05)。结论 VS于术后2h开始发生,以术后6h发生率最高,并且与PCT变化有密切相关性。
Objective To investigate the changes of hemodynamics in patients with vasoplegic syndrome（VS）after off pump coronary artery bypass grafting（OPCAB）. Methods OPCAB patients enrolled in our hospital who were placed Swan-Ganz catheter during the operation,mean arterial pressure（MAP）,central venous pressure（CVP）,pulmonary capillary wedge pressure（PCWP）,cardiac index（CI）,systemic vascular resistance（SVRI） and mixed venous oxygen saturation（Sv O2）were constantly monitored at the time 0.5h,2h,4h,6h,8h and 12 h after operation. Measured procalcitonin（PCT）and C-reactive protein（CRP）at the time 0h,6h,24 h,48h after the operation. All data were analyzed statistically. Results There were 42 patients who were diagnosed with vasoplegic syndrome with a rate of 4.69%. In the VS group,compared with MAP and SVRI in 0.5h after operation, both MAP and SVRI were significantly reduced in 4h,6h and 8h after operation（P〈0.05）,especially in 6h after operation（P〈0.05）. Compared with control group,MAP was significantly reduced in 4h,6h and 8h after operation in VS group（P〈0.05）. SVRI was significantly reduced in 6h and 8h after operation in VS group in comparison with that in control group（P〈0.05）. In 6h after operation, the PCWP and Sv O2 in VS group were significantly lower than those in control group（P〈0.05）;while PCT in 6h after operation in VS group was significantly higher than that in control group,which had a significant correlation with the change of MAP. Conclusion VS occurres at 2h after operation,with the highest incidence rate at 6h after operation,and it is associated with the change of PCT.
出处
《中国现代医药杂志》
2017年第9期27-30,共4页
Modern Medicine Journal of China
