体外循环与非体外循环下冠脉搭桥术患者术中血液动力学的比较

目的比较体外循环(CPB)与非CPB下冠脉搭桥术患者术中血液动力学的变化。方法同期行CPB下冠状动脉搭桥术(CABG)与非CPB下冠状动脉搭桥术(OPCAB)患者各70例,分别为CABG组和OPCAB组,分别在麻醉诱导后手术开始前(术前)和术毕用Swan-Ganz导管监测血液动力学指标。结果与术前比较,两组术毕心率(HR)、平均动脉压(MAP)、肺动脉平均压(PAMP)、肺毛细血管嵌压(PAWP)、中心静脉压(CVP)及左室作功指数(LVSWI)差异无统计学意义(P>0.05),心输出量(CO)、心脏指数(CI)均升高;OPCAB组术毕心搏指数(SVI)升高,体循环阻力指数(SVRI)、肺循环阻力指数(PVRI)降低(P<0.05),CABG组术毕SVI、SVRI、PVRI差异无统计学意义(P>0.05);与CABG组比较,OPCAB组术毕SVRI、PVRI降低(P<0.05)。结论两组患者术后心功能均得到了改善,OPCAB 组在改善心功能、降低体、肺循环阻力方面,优于CABG组。

Comparison of hemodynamics after on-pump and off-pump in the patients undergoing coronary artery bypass graft

Objective To compare the hemodynamic changes between on-pump and off-pump coronary artery bypass graft. Methods One hundred and forty patients were selected with 70 cases of on-pump coronary artery bypass graft (CABG group) and 70 cases of off-pump coronary artery bypass graft (OPCAB group). Swan-Ganz catheter was cannulated to monitor hemodynamics before and at the end of operation. Results Compared with the values before operation, at the end of operation HR, MAP, PAMP, PAWP, CVP and LVSWI unchanged significantly in both groups ( P > 0.05), while CO, CI in both groups and SVI in OPCAB group increased significantly ( P < 0.05) , SVRI and PVRI decreased significantly in OPCAB group( P < 0.05), SVI, SVRI and PVRI did not change significantly in CABG group( P > 0.05). SVRI and PVRI were significantly lower in OPCAB group than those in CABG group (P < 0.05) .Conclusion Cardiac function is significantly improved by on-pump or off-pump coronary artery bypass graft. Off-pump graft is superior to on-pump during coronary artery bypass in degree of improvement cardiac function, reducing the resistance of systemic and pulmonary circulation.