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Giuseppe Nasso¹, Giuseppe Speziale¹, Francesco Bartolomucci²

¹Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy.

Surgical technology international

|October 18, 2023

概括

在心肺绕道 (CPB) 期间,逆行自主原始化 (RAP) 与脉动性流量显著降低了冠状动脉绕道 (CABG) 移植手术的患者的低血压和血管压缩剂的使用. 这一策略改善了血液动力学稳定性,减少了输血需求.

科学领域:

心血管外科心血管外科
麻醉学麻醉学
关键护理医学关键护理医学

背景情况:

血管扩张性休克的一种形式的血管综合征,可以在心脏手术期间复杂化心肺旁路 (CPB).
在冠状动脉旁路移植 (CABG) 过程中,早期的低血压是一个重大问题.

研究的目的:

引入和评估一个外科手术期间的策略,以减少CABG手术期间早期低血压的发生率.
为了比较逆行自主原始化 (RAP) 与脉动性流动的血液动力学效应与标准CPB管理.

主要方法:

一项前性队列研究,涉及100名接受选择性CABG的患者.
研究组 (50名患者) 接受了RAP,3分钟阶段性CPB启动和脉动性流 (PP).
对照组 (50名患者) 接受了没有RAP的标准CPB,具有快速启动和非脉动性 (NP) 流动.

主要成果:

研究小组在CPB期间显示出明显更高的平均动脉压 (MAP),全身血管阻力指数 (SVRI) 和索引氧气输送 (DO2i).
低血压现象减少了 (3对8),在研究小组中,使用诺拉上腺素 (1对8个球) 也减少了.
研究小组在输血时需要更少的红细胞单位 (16 vs 27) 和较低的阳性液体平衡 (750 vs 1450 ml).

结论:

结合RAP,阶段性CPB启动和脉动性流动的周围手术方法有效地保留了MAP,SVRI和DO2i.
这一策略显著减少了CABG患者在CPB期间使用血管收缩剂和输血需求.
需要进一步的研究来验证这种外科手术期间的CPB管理技术.

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