|
|
|
| Application of Corrected Left Ventricular Ejection Time and Stroke Volume Variability in Perioperative Volume Management Guiding Off-pump Coronary Artery bypass Grafting |
| WANG Wei-wei, REN Shao-yu, LIU Pan-pan |
| Shandong Provincial Third Hospital,Jinan Shandong,250031 |
|
|
|
|
Abstract 【Objective】To explore the application value of corrected left ventricular ejection time (LVETc) and stroke volume variability (SVV) in perioperative volume management guidance of off-pump coronary artery bypass grafting (OPCABG). 【Methods】A total of 66 patients with OPCABG were randomly divided into the observer group and the control group, with 33 cases in each group. The volume management was guided by LVETc in the observation group , and it was guided by SVV in the control group. The basic indexes (operation time, total rehydration volume, intraoperative urine volume, intraoperative blood loss, extubation time) of the two groups during the perioperative period were recorded. The hemodynamic indexes at different time points (mean arterial pressure, stroke volume index, heart rate, cardiac index, systemic vascular resistance) and oxygen kinetic indexes at different time points (oxygen supply index, oxygen consumption index, oxygen uptake rate) were measured in the two groups. In addition, the adverse reactions of the two groups were compared as well. 【Results】The total rehydration volume in the observation group was significantly lower than that that in the control group (P<0.05).The heart rate of the observation group was significantly lower than that of the control group when the pericardium was opened (T0) (P<0.05).The cardiac index of the observation group at T0 and T1 (left anterior descending branch bypass), was significantly lower than that of the control group(P<0.05).The systemic vascular resistance of the observation group at T0,T1, T2 (blunt edge branch bypass) and T3 (posterior descending branch bypass) was significantly higher than that of the control group (P<0.05).The oxygen supply index of the observation group was significantly lower than that of the control group at T1,T2 and T3 (P<0.05).The oxygen uptake rate of the observation group was significantly higher than that of the control group at T1,T2 and T3(P<0.05).The difference was not statistically significant in comparison of postoperative cardiovascular adverse reactions between the two groups (P>0.05). 【Conclusion】Taking LVETc as the guidance of volume management can reduce the total rehydration volume, improve the hemodynamics and oxygen kinetic indexes of patients. It reduces the fluid load in tissue space which is worthy of clinical promotion.
|
|
Received: 13 May 2021
|
|
|
|
|
|
[1] ERDOLU B, AS A K, ENGIN M. The relationship between the HATCH score,neutrophil to lymphocyte ratio and postoperative atrial fibrillation after off-pump coronary artery bypass graft surgery[J].Heart Surgery Forum,2020, 23(1):E88-E92.
[2] 何先弟, 解悍东. PiCCO监测下的目标导向集束化治疗脓毒性休克的疗效及相关血流动力学指标对预后的诊断价值[J].中国急救医学,2020, 40(6):536-541.
[3] KURNIYANTA P, UTARIANI A, HANINDITO E,et al. The ultrasonic cardiac output monitor (USCOM) as a tool in evaluating fluid responsiveness in pediatric patients underwent emergency surgery[J].Bali J Anesthesiol,2019, 3(1):19.
[4] 童庆松, 刘佳, 徐英英,等. 老年多病因心力衰竭与心脏彩超左室射血分数的相关性[J].中国老年学杂志, 2020, 40(17):23-26.
[5] 沈金强, 季强, 丁文军,等.心肺转流不停跳与非体外循环冠状动脉旁路移植术治疗射血分数≤35%的冠心病的早期效果比较[J].中华外科杂志, 2018, 56(4):294-298.
[6] VINCENT J L . Intravascular Volume Assessment in the Critically Ⅲ Patient[J].Clin J Am Soc Nephrol Actions,2020,15(4):557-559.
[7] LEE Y H, JANG H W, PARK C H, et al. Changes in plasma volume before and after major abdominal surgery following stroke volume variation-guided fluid therapy: a randomized controlled trial.[J].Minerva Anestesiol,2019, 86(5):507-517.
[8] 蒋雪丽, 王志萍.纠正左室射血时间和每搏量指导单肺移植术中容量治疗的效果:经食道超声多普勒监测[J].中华麻醉学杂志, 2018, 38(3):363-366.
[9] 赵浩天, 龙玲, 任珊,等. 不同指标预测脓毒症休克合并心肌抑制患者容量反应性的准确性:肺部超声指标和PiCCO指标的比较[J].中华麻醉学杂志, 2019, 39(7):862-865. |
|
|
|
2021, Vol. 38 
