Efficacy of pulse index continuous cardiac output monitoring in maintaining adequate blood volume in patients undergoing off-pump coronary artery bypass grafting / 中华麻醉学杂志

ABSTRACT

Objective To investigate the efficacy of pulse index continuous cardiac output (PICCO) monitoring in maintaining adequate blood volume in patients undergoing off-pump coronary artery bypass grafting (OP-CABG).Methods Forty-seven ASA Ⅰ-Ⅲ patients aged 43-64 yr weighing 50-85 kg undergoing OP-CABG were included in this study. Global end-diastolic volume (GEDV), extravascular lung water (EVLW), global end-diastolic volume index (GEDVI), MAP, cardiac output (CO) and cardiac index (CI) were monitored by using PICCO monitor before induction of anesthesia (baseline), at the end of operation and at 4 and 8 h after operation. Blood volume was maintained during operation by adjusting the volume and infusion rate of succinyl gelatin and lactated Ringer's solution according to volume indexes and hemodynamic indexes. GEDVI was maintained at 600-800 ml/m2 and Hct≥30% by transfusion of whole blood or erythrocyte suspension;MAP was maintained at 70-90 mm Hg by intravenous infusion of nitroglycerine (0.5-1.0 μg·kg-1·min-1) or diltiazem (2-6 μg·kg-1·min-1); HR was maintained at≤75 bpm by intravenous dopamine infusion (3-5 μg·kg-1·min-1). The oxygen delivery index(DO2 I) and oxygen consumption index (VO2 I) were calculated. Arterial blood samples were taken for blood gas analysis. Results The CI, DO2I and VO2I were increased at the end of operation, and at 4 h and 8 h after operation as compared with the baseline values before induction of anesthesia (P<0.05 or 0.01). Conclusion Perioperative blood volume can be well maintained with PICCO monitoring in patients undergoing off-pump coronary artery bypass grafting.