目标导向血流动力学管理对高危心血管患者术后心肌损伤的影响*

Clinical research of goal-directed hemodynamic management reduces the post-operative myocardial injury of high-risk cardiovascular patients*

摘要:

目的 研究目标导向血流动力学管理对高危心血管患者术后心肌损伤的影响。方法 选取择期行开腹手术的高危心血管患者44例作为研究对象。随机分为两组：传统管理组和目标管理组，常规监测并快速诱导插管，术中管理：传统管理组由主治以上麻醉医生根有创动脉血压（ABP）和中心静脉压（CVP），以经验调控输液量及给予血管活性药物或正性肌力药物；目标管理组行心排量监测，根据心指数（CI）、每博量变化值（△SV）、舒张压（DBP）等指标按设定流程调控输液量及给予血管活性药物和正性肌力药物。分别记录两组一般情况、术前、术后24?h、术后48?h心肌损伤标志物水平，住院期间心肌梗死发生情况以及术后30?d预后情况。结果 不同时间点两组患者肌钙蛋白T、CKMB及BNP均有差异（P?<0.05）。组间肌钙蛋白T有差异（P?< 0.05）；两组患者肌钙蛋白T和BNP变化趋势有差异（P?<0.05）；两组住院期间心梗发生率和术后30?d存活率 比较，差异无统计学意义（P?>0.05）。结论 应用CI联合△SV对高危心血管患者进行血流动力学管理，可降低 其术后肌钙蛋白T水平。

Abstract:

Objective To study the effect of goal-directed hemodynamic management on postoperative myocardial injury in high-risk patients with cardiovascular disease. Methods Selected 44 patients with high risk of cardiovascular diseases who underwent laparotomy were randomly divided into two groups: traditional management group and target management group. Regular monitoring and rapid induction of intubation were performed. Intraoperative management: according to ABP and CVP, attending doctors regulated the use of infusion and vasoactive drugs by experience in the traditional management group; according to CI, △SV and DBP, the cardiac output of patients in the target management group was monitored to regulates the use of infusion and vasoactive drugs. The general condition and the levels of myocardial injury markers 24 hours before and 48 hours after surgery, the incidence of myocardial infarction during hospitalization and the prognosis 30 days after surgery were recorded respectively in the two groups. Results There were differences in troponin T, CKMB and BNP between the two groups at different time points (P??0.05). Conclusion The hemodynamic management of high-risk cardiovascular patients by CI combined with △SV can decrease postoperative troponin level.