Application of intraoperative arterial pressure-based cardiac output monitoring for patients undergoing coronary artery bypass grafting surgery

作     者：LU Jia-kai ZHU Chen JING He WANG Yi-jun QING En-ming 

作者机构：Department of Anesthesiology Beijing Anzhen Hospital CapitalMedical University Beijing 100029 China Department＇-of Anesthesiology China Coal General HospitalBeijing 100029 China 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2012年第125卷第12期

页      面：2099-2103页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：arterial pressure-based cardiac output pulmonary artery catheter hemodynamics, cardiac output off-pump coronary artery bypass grafting 

摘      要：Background For patients undergoing off-pump coronary artery bypass grafting （OPCABG）, it is important to establish a hemodynamic monitoring system to obtain powerful parameters for better intraoperative treatment. This study aimed to observe the clinical feasibility of arterial pressure-based cardiac output （APCO） for cardiac output （CO） monitoring and to evaluate the correlation between APCO and pulmonary artery catheter （PAC） for CO measurement for patients undergoing OPCABG intraoperatively. Methods Fifty patients of American Society of Anaesthesiologists （ASA） classification Ⅱ-Ⅲ, undergoing elective OPCABG at Beijing Anzhen Hospital were randomly enrolled into this study. All patients were assigned to CO monitoring by PAC and APCO simultaneously. Patients with pacemaker, severe valvular heart disease, left ventricular ejection fraction （EF） 〈40%, cardiac arrhythmias, peripheral vascular disease, application of intra-aortic balloon pump （IABP） and emergent diversion to cardiac pulmonary bypass were excluded. The radial artery waveform was analyzed to estimate the stroke volume （SV） and heart rate （HR） continuously. CO was calculated as SV × HR; other derived parameters were cardiac index （CI）, stroke volume index （SVI）, systemic vascular resistance （SVR）, and systemic vascular resistance index （SVRI）. PAC was placed via right internal jugular vein and the correct position was confirmed by PAC waveforms. Continuous cardiac output （CCO）, CI and other hemodynamic parameters were monitored at following 5 time points： immediate after anesthesia induction （baseline value）, anastomosis of left internal mammary artery to left anterior descending artery （LAD）, anastomosis of left circumflex （LCX）, anastomosis of posterior descending artery （PDA） and immediate after sternal closure. Results In the 50 patients, preoperative echocardiography measured left ventricular EF was （52.8±11.5）%, and 35 patients （70%） showed regional wall motion abnormalities. The correlation coeffic