| Objective To observe the feasibility of arterial pressure-based cardiac output (APCO) for cardiac output monitoring and to evaluate the correlation of APCO and pulmonary artery catheter (PAC) for cardiac output measurement in patients undergoing off-pump coronary atery bypass grafting (OPCABG).Methods Fifty patients undergoing selective off-pump coronary artery bypass grafting were enrolled in present study. All patients accepted PAC and APCO monitoring for cardiac output(CO) at every time point. Following data were collected:CO, cardiac index(CI), strock volume(SV), stroke volume index(SVI), systematic vascular resistance(SVR), systematic vascular resistance index(SVRI) at post-induction of anaesthesia induction(basice value), left internal mammary artery to left anterior descending artery anastomosis(LAD), left circumflex anastomosis(LCX), posterior descending artery anastomosis (PDA), post-sternal closure.Results The patients’situation about their age, gende, body surface area, left ventricular ejection fraction, coexisting hypertension, diabetes, old myocardial infarction, actue myocardial infarction were recorded. Statistical results including CO, CI, SV, SVI, SVE, SVRI, MAP and other hemodynamic parameters were record and analyzed at everyt timepoint. The statistical analysis revealed that the baseline data of APCO was 4.8±1.00 L/min, APCO at anastomosis of left internal mammary artery to left anterior descending artery, left circumflex, posterior descending artery and after sternal closure were 4.5±1.00 L/min,3.9±0.78 L/min,4.0±0.63 L/min and were 4.7±0.90 L/min respectively. The APCO monitoring results of APCO and PAC have changed in the procedure of observation and there was no significant difference between the every result of APCO and PAC. The correlation index derived from both APCO and PAC were 0.70,0.79,0.78,0.74,0.85.The bias of CI derived from both APCO and PAC were 0.06±0.39L/min/m2,0.12±0.48L/min/m2,0.06±0.26L/min/m2,0.06±0.27L/min/m2 and 0.05±0.30 L/min/m2 respectively. Statistical results demonstrated that CO from two kinds of monitoring methods were significantly decreased at left circumflex anastomosis and posterior descending artery anastomosis contrasting to the results at baseline and left internal mammary artery to left anterior descending artery anastomosis. The lowest point of CO values derived from PAC observed at point of posterior descending artery anastomosis and at, APCO left circumflex anastomosis point in APCO monitoring respectively. The variation magnitudes of CO values from both APCO and PAC were not significant different at points of left circumflex anastomosis and posterior descending artery anastomosis (P<0.05)There were no significant differences in other parameters derived from both APCO and PAC. The results of Bland-Altman analysis demonstrated that the results derived from both methods of hemodynamic monitoring had excellent correlation.Conclusion The hemodynamic monitoring results derived from APCO has excellent correlation with monitoring results from PAC in patients undergoing OPCABG The results of APCO is applicable for monitoring in OPCABG characterized by its results displayed timely, accurately and continuously. |
