Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Outcomes Research Consortium, Cleveland, OH, USA.
J Clin Monit Comput. 2021 Aug;35(4):827-834. doi: 10.1007/s10877-020-00541-8. Epub 2020 Jun 5.
Peroral endoscopic myotomy (POEM) is natural orifice transluminal endoscopic surgery to treat esophageal achalasia. During POEM, cardiovascular dynamics can be impaired by capnoperitoneum, capnomediastinum, and systemic carbon dioxide accumulation. We systematically investigated changes in cardiovascular dynamics during POEM. We included 31 patients having POEM in this single-center prospective observational study. Before and every 5 min during POEM we measured mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), stroke volume index (SVI), and systemic vascular resistance index (SVRI) using non-invasive finger cuff-derived pulse wave analysis. During POEM, the median MAP was higher than the median baseline MAP of 77 (67;86) mmHg. HR (median at baseline: 67 (60;72) bpm), CI (2.8 (2.5;3.2) L/min/m), SVI (42 (34;51) mL/m), and SVRI (1994 (1652; 2559) dyn × s × cm × m) remained stable during POEM. Mixed model-derived 95% confidence limits of hemodynamic variables during POEM were 72 to 106 mmHg for MAP, 65 to 79 bpm for HR, 2.7 to 3.3 L/min/m for CI, 37 and 46 mL/m for SVI, and 1856 and 2954 dyn × s × cm × m for SVRI. POEM is a safe procedure with regard to cardiovascular dynamics as it does not markedly impair MAP, HR, CI, SVI, or SVRI.
经口内镜下肌切开术（POEM）是一种通过自然腔道内镜手术来治疗食管失弛缓症的方法。在 POEM 过程中，由于气腹、气纵隔和全身二氧化碳积聚，心血管动力学可能会受到影响。我们系统地研究了 POEM 过程中心血管动力学的变化。在这项单中心前瞻性观察研究中，我们纳入了 31 例行 POEM 的患者。在 POEM 之前和每 5 分钟测量一次平均动脉压（MAP）、心率（HR）、心指数（CI）、每搏量指数（SVI）和全身血管阻力指数（SVRI），使用非侵入性手指袖带衍生的脉搏波分析。在 POEM 过程中，中位数 MAP 高于中位数基线 MAP（77（67；86）mmHg）。HR（基线中位数：67（60；72）bpm）、CI（2.8（2.5；3.2）L/min/m）、SVI（42（34；51）mL/m）和 SVRI（1994（1652；2559）dyn × s × cm × m）在 POEM 过程中保持稳定。POEM 期间血流动力学变量的混合模型衍生 95%置信区间为 MAP 为 72 至 106mmHg，HR 为 65 至 79bpm，CI 为 2.7 至 3.3L/min/m，SVI 为 37 至 46mL/m，SVRI 为 1856 至 2954dyn × s × cm × m。POEM 是一种安全的手术方法，因为它不会显著损害 MAP、HR、CI、SVI 或 SVRI。
