Clinical Study On Volume Management Of Single Lung Transplantation By Transesophageal Doppler

Objective To evaluate the value of transesophageal Doppler in volume management during single lung transplantation.Methods Twenty-six cases of single lung transplantation,aged 18-60 years,BMI18.0-25.0 kg/m²,ASA?or?grade were selected.Twelve cases underwent left lung transplantation and the others underwent right lung transplantation.All patients were divided into two groups by random number table?n=13?:the control group?group C?and the test group?group T?.In group T,corrected left ventricular ejection time?LVETc?and stroke volume?SV?were used for fluid management.However,the group C was given fluid infusion according to CVP.After double lumen endobronchial intubation,all patients were monitored LVETc and SV by transesophageal ultrasound,and the right internal jugular vein puncture was used to monitor the pulmonary arterial pressure?PAP?and CVP.During liquid treatment,when mean arterial pressure?MAP?was below 70mmHg,0.1⁰.2mg metaraminol was administered until MAP reached 70¹05mmHg.HR,MAP,CVP,PAP,LVETc and SV were recorded at the time of 5 min before one lung ventilation?O₀?,pulmonary artery occlusion?C₀?and pulmonary artery opening?R₀?,the right time of one lung ventilation?O₁?,pulmonary artery occlusion?C₁?and pulmonary artery opening?R ₁?,15 min after one lung ventilation?O₂?,pulmonary artery occlusion?C₂?and pulmonary artery opening?R ₂?,30 min after one lung ventilation?O₃?,pulmonary artery occlusion?C₃?and pulmonary artery opening?R ₃?,1 hour?C₄?and two hours?C₅?after pulmonary artery occlusion,and the end of surgery?E₀?.Oxygenation index and lactate levels of radial artery were analyzed at O₀,O₃,C₃,R₃and E₀.Donor lung cold ischemia time,total operation time,single lung ventilation time and pulmonary artery occlusion time were recorded.Total transfusion volume and the volume during one lung ventilation?before pulmonary artery occlusion?,pulmonary artery occlusion and pulmonary artery opening were calculated.Urine output,blood loss,autotransfusion volume,postoperative extubation time and the dosage of urine furosemide and metaraminol were recorded.Adverse events,such as pharyngeal mucosal injury,and perforation,hemorrhage or local hematoma of esophagus were observed.Results HR,CVP,PAP increased and SV decreased in all patients at O₂?P<0.05?.Immediately after pulmonary artery occlusion,HR,CVP and PAP increased,LVETc and SV decreased?P<0.05?.MAP,CVP,PAP,LVETc and SV decreased,and HR increased at the time of pulmonary artery opening?P<0.05?.The levels of MAP,CVP,LVETc and SV in group T were higher than that in group C at the time of O3,C0^C5,R0^R3 and E0?P<0.05?.The dosage of metaraminol in group C was more than that of group T.The oxygenation index decreased at O₃ and increased at C₃,R₃ and E₀compared with O₀?P>0.05?.The blood lactate of group T were lower than those in group C,and the oxygenation index were higher than those in group C at C3,R3and E0?P<0.05?.The total amount of transfusion and the amount of colloid or crystalloid transfusion in group T were larger than those in group C throughout the operation,during single lung ventilation?before pulmonary artery occlusion?and pulmonary artery occlusion?P<0.05?.While the volume of fluid infusion and the amount of crystalloid or colloid infusion in group C were larger than those in group T during pulmonary artery opening?P<0.05?.The urine volume of group T was larger than that in group C,and the extubation time was less than that in group C?P<0.05?.There was no significant difference in the dosage of furosemide and the incidence of adverse events between the two groups?P>0.05?.Conclusion Transesophageal Doppler is safe and effective for volume monitoring in patients undergoing single lung transplantation,it can maintain the stability of hemodynamics during operation and improve the prognosis of the patients.