| Abstract | 「要旨」麻酔中の指尖容積脈波の微細な変動の解析目的で, コンピューターを用いて脈波波形面積(PGA)を計算し, 心拍出量(CO), 収縮期血圧(SPB), 心拍数(HR)と組合わせ, 開心術患者に対する気管内挿管血行動態の解析を試みた. 対象は冠動脈再建術症例(CABG), 大動脈弁置換術症例(AVR), 僧帽弁置換術症例(MVR)とした. 結果は挿管による侵襲に対し, MVR群及びCABG群ではPGAとCOに挿管前後の値に有意差を認め, AVR群ではすべてに認めなかった. MVR群とCABG群では挿管という侵襲に対し安定したSBP, HRを示すが, 実際にはPGAが減少し, 後負荷の増加によりCOは低下している. AVR群では他2群に比し, 挿管前の末梢循環が保たれた高CO状態であるが, MVR群では挿管前よりPGAは抑制され, 低CO状態を呈している. 麻酔導入時, PGA測定は正確な循環動態の把握に有用と思われる. |
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| Abstract | The present study was designed to evaluate peripheral hemodynamic changes before and after endotracheal intubation. Cardiac output (CO), systolic blood pressure (SBP), and heart rate (HR) were measured. Plethysmogram wave area (PGA) was calculated by computer in patients undergoing mitral valve replacement (MVR), aortic valve replacement (AVR) and coronary artery bypass grafting (CABG). In MVR and CABG, although three were significant differences in PGA and CO (p<0.01) before and after endotracheal intubation. SBP and HR did not change significantly. Decrease in PGA after intubation in these groups was caused by increase in afterload and decrease in CO. In contrast, there were no significant changes in all parameters in AVR. There were good peripheral circulation in this group due to high output state. CO in MVR decreased even before intubation and further decreased after intubation. It is concluded that calculation of PGA is noninvasive and a good parameter to show hemodynamic changes before and after intubation for cardiac surgery. |
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