非体外循环冠状动脉旁路移植术的血流动力学研究

目的：分析非体外循环冠状动脉旁路移植术中血流动力学的变化。方法：2000年6月至2001年1月，连续32例病人接受非体外循环冠状动脉旁路移植术，术中、术后对各吻合血管的血流动力学指标进行持续监测。全组完成前降支吻合32例、右冠状动脉26例、回旋支28例、对角支8例。结果：本组死亡例。行前降支冠状动脉吻合时血流动力学指标无明显变化。右冠状动脉吻合时影响右心功能。回旋支及对角支冠状动脉吻合时对血流动力学有明显的影响，导致平均肺动脉压（MPAP）、肺毛细血管楔压（PAWP）、中心静脉压（CVP）明显升高，每搏指数（SVI）及左室每搏功指数（LVSWI）有明显下降；心排指数（CI）有一定的下降趋势。行主动脉近心端吻合时尽管已无心脏搬动，但MPAP、SVRI及肺循环阻力指数（PVRI）仍较诱导后有明显升高，CI有明显下降。术毕及术的2、6、16h各血流动力学指标趋于正常，CI有明显改善。结论：非体外循环冠状动脉旁路移植行前降支及右冠状动脉吻合时对血流动力学影响较小，回旋支及对角支冠状动脉吻合时对血流动力学有明显的影响，术毕及术后2、6、16h各血流动力学指标趋于正常，心脏功能有明显改善。

Analysis of hemodynamic changes during off-pump coronary artery bypass grafting

Objective: To analysis of hemodynamic changes during coronary artery bypass grafting without cardiopulmonary bypass. Methods: From Jun.2000 to Jan.2001, 32 consecutive patients received off pump coronary artery bypass grafting (CABG) and the hemodynamic changes were monitored during operation. The anastomosis sites included 32 at the left anterior descending artery (LAD), 26 at the right coronary artery (RCA), 28 at the circumflex (Cx), and 8 at the diagonal branch artery (D). Results: There was one postoperative death with a mortality rate of 3 1%. There were no hemodynamic changes during LAD anastomosis. Only slight hemodynamic changes occurred during RCA anastomosis. Hemodynamics changed significantly during Cx and D anastomosis with the marked elevation of MPAP, PAWP, CVP and marked decrease of SVI, LVSWI. CI also decreased during this period. Although there was no heart displacement during aortic anastomosis, MPAP, SVRI, PVRI elevated and CI decreased significantly. Hemodynamics tended to be stable and CI improved at the end of operation and 2 hours, 6 hours and 16 hours post operation. Conclusion: There were no or little hemodynamic changes during the LAD and RCA anastomosis in off pump CABG, while hemodynamics changed significantly during Cx and D anastomosis. Hemodynamics became stable and CI improved after operation.