Clinical research on the perioperative hemodynamic changes recorded by MostCare/PRAM system in the off-pump coronary artery bypass grafting surgery
- VernacularTitle:不停跳冠状动脉旁路移植术中应用MostCare/PRAM监测系统进行血流动力学监测的临床研究
- Author:
Yixi ZOU
1
;
Jinsong LIU
2
;
Mi CHEN
1
;
Fangjiong HUANG
1
;
Xiubin YANG
1
Author Information
1. Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P.R.China
2. Department of Cardiac Surgery, Tianjin Teda International Cardiovascular Hospital, Tianjin, 300000, P.R.China
- Publication Type:Journal Article
- Keywords:
Off-pump coronary artery bypass grafting;
pulse recorded analysis method;
passive leg raising test;
cardiac circle efficiency;
maximum pressure gradient
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2021;28(01):104-109
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the perioperative hemodynamic changes of off-pump coronary artery bypass grafting (OPCABG) patients monitored by pulse recorded analysis method (MostCare/PRAM devices) and its relationship with the prognosis. Methods A total of 89 patients who underwent OPCABG from October 2016 to January 2017 in Beiijng Anzhen Hospital were included, including 53 males and 36 females aged 60.50±8.40 years. The hemodynamic changes were recorded. The patients were divided into two groups (a major adverse cardiovascular events group and a stable group) according to whether major adverse cardiovascular events occurred or not. The difference of hemodynamic changes between the two groups was analysed. Results The mean percentage increases of stroke volume (SV) in the passive leg raising (PLR) test before opening chest and after chest closure were 23.00%±3.20% and 29.40%±3.70%, respectively. Hemodynamic data were analysed seven times, namely, anaesthesia, opening chest, heparin administration, coronary artery bypass grafting, protamine administration, thoracic closure and after operation. SV was significantly decreased during above periods, while systemic vascular resistance index (SVRI) was significantly increased. Cardiac circle efficiency (CCE) and maximum pressure gradient (dP/dT) were decreased after anaesthesia, and decreased to the lowest value during the procedure of bypass grafting, and then they began to increase gradually after the manipulation of bypass grafting was finished. Stroke volume variation (SVV) and pulse pressure variation (PPV) were slightly decreased during anaesthesia, then increased significantly through the whole surgery. Major adverse cardiovascular events occurred in 9 patients and 4 of them died. The basic mean values of SVRI, SVV and PPV of patients in the major adverse cardiovascular events group before opening chest were significantly higher than those of patients in the stable group. There was no significant difference in the mean values of CCE, dP/dT or SV between the two groups. There was no significant correlation between the prognosis and the mean values of SVRI, SVV, PPV, CCE, dP/dT or SV. Conclusion The hemodynamic indexes are not stable, thus, it is necessary to monitor the perioperative hemodynamic changes of OPCABG patients timely by MostCare/PRAM device and adjust treatment measures accordingly.
