| To investigate the method of evaluating the cardiac function and capacity monitoring for patients in OPCABG: Flo Trac/VigileoTMand Swan-Ganz.Fifty patients coming from The General Hospital Of The Air Forc e undergoing off-pump Coronary Artery Bypass Grafting(OPCABG)were cruited randomly between 2014.3 and 2016.1. The group A cont ains of 25 patients for NYHAⅠ-Ⅱ. The group B contains of 25 pa tients for NYHAⅢ-Ⅳ. The patients are fifty years to seventy years and ASAⅡ~Ⅳ. All patients accepted cardiac output monitoring b y Swan-Ganz catheter and Flo Trac/Vigileo system at the same time.Following data were designed to be monitored including continuous cardiac output(CCO), cardiac index(CI), stroke volume(SV), pulmona ry artery wedge pressure(PAWP), stroke volume variation(SVV), syste mic vascular resistance(SVR), systemic vascular resistance index(SVR I), mixed venous oxygen saturation(Sv O2), right ventricular ejection fractions(RVEF), right ventricular end-diastolic volume(RVEDV) and other hemodynamic parameters at 12 points: before anaesthesia induct ion(T0), after anaesthesia induction(T1), Trendelenburg position 10。(T2), Trendelenburg position 20。(T3), Left low right high positi on10。(T4), Left low right high position20。(T5), after the thoracotomy(T6), anastomosis of left internal mammary artery to left anterior desc ending artery(LAD)(T7), right coronary artery anastomosis(RCA)(T8),left circumflex coronary artery anastomosis(LCX)(T9), before stern al closure(T10), after sternal closure(T11). Simultaneously, compar e the correlation between CO/CI of Flo Trac/VigileoTMand CO/CI ofVigilance.And compare the PAWP,RVEDV,Sv O2 and other hemodyna mic parameters.Our results show that:(1)Group A:(1)During the different period, the correlation coefficient between CIF and CIV was respectively 0.683,0.862,0.875,0.894,0.885,0.943 at T0-T5,P<0.01,and 0.794,0.638,0.572,0.597,0.635,0.817 at T6-T11,P<0.05.(2)During the different period, the correlation coefficient between SVV and RVEDV was respectively-0.612,-0.734,-0.744,-0.718,-0.645,-0.663,-0.798 at T0-T5、T11, P<0.05,and the correlation coefficient between SVV and RVEDV was re spectively-0.495,-0.488,0.200,-0.024,-0.555 at T6-T10.(3)During the T2-T5, the correlation coefficient between △SVV and △RVEDV was respectively-0.536,-0.812,-0.793,-0.832,P<0.05.(4) During the T1-T6 and T10-T11, the correlation coefficient between PAWP and RVED V was 0.542、0.446、0.415、0.517、0.461、0.571 and 0.443、0.428(P<0.05),but PAWP is badly related to RVEDV at T7-T9.(5) Duri ng the T1-T11,the correlation coefficient between Sv O2 and RVEDV was 0.594、0.497、0.524、0.581、0.612、0.573、0.627、0.624、0.601、0.546、0.519(P<0.05).(6)During the T1-T11,the correlation coefficie nt between SVRF and SVRV was 0.73、0.68、0.71、0.69、0.62、0.66、0.63、0.57、0.52、0.49、0.54、0.63(P<0.05).(2)Group B:(1)During the different period, the correlation coefficient between CIF and CIV was respectively 0.674,0.693,0.597,0.559,0.602,0.574, 0.492,0.438,0.572,0.425,0.635,0.717,P<0.05.(2)During the different period, the correlatio n coefficient between SVV and RVEDV was respectively-0.673,-0.592,-0.487,-0.553,-0.478,-0.512,-0.625 at T0-T5、T11,P<0.05,and th e correlation coefficient between SVV and RVEDV was respectively-0.322, 0.224,-0.117,-0.356,(P>0.05)at T6-T10.(3)During the T2-T5, the c orrelation coefficient between △SVV and △RVEDV was respectively-0.451,-0.469,-0.402,-0.434,P<0.05.(4)During the T1-T6 and T10-T11, the correlation coefficient between PAWP and RVEDV was 0.504、0.492、0.489、0.527、0.531、0.548 and 0.524、0.518(P<0.05),but PAWP is badly related to RVEDV at T7-T9.(5)During the T1-T5, the c orrelation coefficient between Sv O2 and RVEDV was 0.317、0.278、0.291、0.243、0.273(P>0.05),but the correlation coefficient was 0.591、0.582、0.537 、0.491、0.457 at T7-T11.(6)During the T1-T11,the co rrelation coefficient between SVRF and SVRV was 0.70、0.74、0.67、0.65、0.72、0.64、0.59、0.61、0.54、0.48、0.53、0.56(P<0.05).(3)Comparition of interclass parametric:(1)comparition of interclass CIF and interclass CIV: group B less than group A significantly at T0-T11(P < 0.05).(2)comparition of interclass RVEDV: group B greater than group A significantly at T8-T10(P < 0.05).(3)comparition of int erclass SVV: group B greater than group A significantly at T3- T6、T11(P < 0.05).(4)comparition of interclass PAWP: group B greater than group A significantly at T3- T5、T8-T11(P < 0.05).(5)compariti on of interclass Sv O2:group B less than group A significantly at T1-T11(P < 0.05).The following conclusions can be drawn:(1)NYHA Ⅰ- Ⅱ(1) The monitoring CI and SVR results derived from Flo Trac/VigileoTMand Vigilance are well correlated in patients.(2) SVV reflects accurately the capacity of circulation at the station of sternal closure. SVV can not reflects accurately the capacity of circulation at the time of coronary artery anastomosis.(3) PAWP can not reflects accurately the capacity of circulation at the time of coronary artery anastomosis but other point in OPCABG.(4) Sv O2 reflects accurately the capacity of circulation for the patients.(2)NYHA Ⅲ- Ⅳ(1) The monitoring CI results derived from Flo Trac/VigileoTMand Vigilance are well correlated in patients,but CIF underestimate the real cardiac index.(2)SVV can not reflects accurately the capacity of circulation.(3)PAWP can not reflects accurately the capacity of circulation at the time of coronary artery anastomosis but other point in OPCABG.(4)Sv O2 can reflect accurately the capacity of circulation for the patients during the T7-T9. |
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