脉搏指示连续心排血量技术在肺移植术中及术后的应用11例

目的 观察脉搏指示连续心排血量(PiCCO)技术在肺移植术中及术后的应用并评价其价值.方法 行肺移植术的患者11例,其中6例行单肺移植术,5例行序贯式双肺移植术.诱导麻醉后,经颈内和锁骨下静脉穿刺置入中心静脉导管和Swan-Ganz漂浮导管,取左侧股动脉穿刺置入PiCCO导管.记录麻醉后双肺通气时、单肺通气时、肺动脉夹闭时、肺动脉开放时、术毕、术后8h和术后24h的血流动力学数据及PiCCO监测数据.结果 单肺通气时和肺动脉夹闭时的心输出量和间断心输出量低于双肺通气时(P<0.05),肺动脉开放时和术毕的心输出量和间断心输出量高于单肺通气时和肺动脉夹闭时(P<0.05),心输出量与间断心输出量的相关系数为0.84(P<0.01).单肺通气时和肺动脉夹闭时的肺动脉压明显高于双肺通气时(P<0.05),肺动脉开放时和术毕的肺动脉压则明显低于单肺通气时和肺动脉夹闭时(P<0.05).单肺通气时和肺动脉夹闭时的脉压变异明显高于双肺通气时(P<0.05).全心舒张末期容积指数、胸腔内血容积指数与每搏输出量指数相关(r=0.69,P<0.01),中心静脉压、肺动脉楔压与每搏输出量指数不相关,血管外肺水指数与肺血管通透性指数相关(r=0.82,P<0.01).结论 肺移植术中及术后应用PiCCO技术可反映血流动力学变化,同时反映心脏前负荷以及肺血管通透性的变化,指导液体输入和呼吸机模式的调整.

Application of pulse indicator continuous cardiac output during and after lung transplantation

Objective To evaluate the value of pulse indicator continuous cardiac output (PiCCO) measurement during and after lung transplantation. Methods Eleven cases of ASA class Ⅲ or Ⅳ aged from 34 to 68 years undergoing lung transplantation were enrolled in this randomized,double-blind trial (7 cases of idiopathic pulmonary fibrosis patients, 3 cases of COPD and 1 case of silicosis patent), the CVP, Swan-Ganz, and PiCCO catheter were inserted in all patients via subclavical vein, internal jugular vein and left femoral artery respectively. The paramcters such as haemodynamics and PiCCO data of all patients were recorded at T0, T1, T2, T3, T4, T5 and T6 (T0, T1, T2, T3, T4, T5 and T6 were represented the time of the beginning of double-lunged and single-lunged ventilation, lung artery clipping and opening, operation completing and 8 or 24 h after operation respectively). At the end of this clinical trial, all measurement data were expressed as mean ± standard deviation, and correlation analysis was used for PiCCO versus CCO, ELWI versus PVPI and SVI versus GEDI, ITBI, CVP and PAWP, disposed by SPSS 13.0 software. Results PAP value at T1 and T2 grew larger than at T0 (P<0.05), so did the PPV (P<0.05), whereas it at T3 and T4 went down extremely against the data of T1 and T2 (P<0.01). Compared to T0, PiCCO and CO at T1 and T2 fallen off obviously (P<0.05). But, in contrast, at T3 and T4 they increased distinctly versus at T1 and T2 (P<0.05). GEDI, ITBI, ELWI and PVPI at T3 and T4, were larger than at T0, and those at T5 and T6 were larger than at T3 and T4 (P<0.05). There was a positive correlation between SVI versus GEDI and ITBI (r=0.69, P<0.01 ). In contrast, no correlation was observed between SVI versus CVP and PAWP (r=0.23, P>0. 05). Related coefficients of ELWI and PVPI, and PiCCO and CCO were 0.82 and 0.84 respectively (P<0.01 ). Conclusion PiCCO monitoring can reflect the change of pulmonary vascular permeability precisely, which maybe provide timely and considerable evidence and proof for clinicians to diagnose and treat during and after lung transplantation.