[原位肝移植中通过全心舒张末期容积和胸腔内血容量进行围手术期心脏前负荷监测的准确性]

[Accuracy of perioperative cardiac preload monitoring by global end-diastolic volume and intrathoracic blood volume in orthotopic liver transplantation].

作者信息

Zhang Hong-fei, Xu Shi-yuan, Ye Xiao-ping, Zhou Jian, Liang Qi-bo, Xu Ping, Zhang Xin-jian

机构信息

Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.

出版信息

Nan Fang Yi Ke Da Xue Xue Bao. 2010 Jul;30(7):1577-9.

PMID:20650770

Abstract

OBJECTIVE

To investigate the clinical value of global end-diastolic volume (GEDV) and intrathoracic blood volume (ITBV) in perioperative monitoring of the cardiac preload in patients undergoing orthotopic liver transplantations (OLT).

METHODS

Eight ASA III or IV patients aged 42-50 years undergoing OLT without venovenous bypass under general anesthesia were enrolled in this study. Before the induction, a thermodilution femoral artery catheter was inserted into the femoral artery under local anesthesia and connected to a PiCCOplus system to monitor ITBV and GEDV. A CCO catheter was inserted into the right internal jugular vein to monitor the pulmonary artery obstruction pressure (PAOP), central venous press (CVP) and stroke volume (SVPAC). Anesthesia was induced with a combination of midazolam (0.1 mg/kg), propofol (1 mg/kg) and fentanyl (3 microg/kg). Pipecuronium (0.1 mg/kg) was given to facilitate naso-endotracheal intubation. Before anesthesia (T0) and at 10 min before the anhepatic phase (T1), 10 min after anhepatic phase (T2), 10 min after neohepatic phase (T3) and at the end of surgery (T4), all the TPTD and CCO parameters were measured by injecting 10 ml cold saline solution (below 8 degrees celsius;) via the distal port of the central venous catheter.

RESULTS

ITBV and GEDV at T2 were significantly lower than those at T0, T1, T3 and T4 (P<0.05). SVPAC at T2 was dramatically decreased compared with that at T0 and T1 (P<0.05). The changes in the pressure preload parameters of the pulmonary artery catheter (PAOP and CVP) did not correlate to the changes in SVPAC, whereas the changes in the volume preload parameters (ITBV and GEDV) of the TPTD was significantly correlated to the changes in SVPAC (P<0.01). PAOP and CVP did not correlate to the changes in ITBV and GEDV.

CONCLUSION

ITBV and GEDV are more reliable than PAOP and CVP in perioperative monitoring of the cardiac preload in patients undergoing OLT.

摘要

目的

探讨全心舒张末期容积（GEDV）和胸腔内血容量（ITBV）在原位肝移植（OLT）患者围手术期心脏前负荷监测中的临床价值。

方法

本研究纳入8例年龄在42 - 50岁、ASA III或IV级、在全身麻醉下无静脉 - 静脉转流的OLT患者。诱导前，在局部麻醉下将热稀释股动脉导管插入股动脉，并连接至PiCCOplus系统以监测ITBV和GEDV。将CCO导管插入右颈内静脉以监测肺动脉阻塞压（PAOP）、中心静脉压（CVP）和每搏量（SVPAC）。采用咪达唑仑（0.1 mg/kg）、丙泊酚（1 mg/kg）和芬太尼（3 μg/kg）联合诱导麻醉。给予哌库溴铵（0.1 mg/kg）以利于经鼻气管插管。在麻醉前（T0）、无肝前期前10分钟（T1）、无肝期后10分钟（T2）、新肝期后10分钟（T3）及手术结束时（T4），通过经中心静脉导管远端端口注入10 ml冷盐水溶液（低于8摄氏度）测量所有热稀释心输出量（TPTD）和CCO参数。

结果

T2时的ITBV和GEDV显著低于T0、T1、T3和T4时（P<0.05）。与T0和T1时相比，T2时的SVPAC显著降低（P<0.05）。肺动脉导管压力前负荷参数（PAOP和CVP）的变化与SVPAC的变化无关，而TPTD的容量前负荷参数（ITBV和GEDV）的变化与SVPAC的变化显著相关（P<0.01）。PAOP和CVP与ITBV和GEDV的变化无关。