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目的 :观察晚期肿瘤患者体外静脉 静脉转流热灌注治疗 (VV PISH)期间血流动力学的变化。方法 :18例晚期肿瘤患者 ,年龄 2 9～ 73岁 ,ASAⅠ～Ⅱ级 ,术前检查心肺功能基本正常 ,无脑转移和大血管内癌栓形成。麻醉诱导后行桡动脉、右锁骨下静脉穿刺测压 ,通过右颈内静脉放置Swan Ganz导管行心功能监测。双侧股静脉经皮穿刺插入股静脉插管 ,连接体外热疗机 (TEMETSYSTEM 10 0 0 ) ,经全身肝素化后行热灌注治疗。术中监测食管温度与直肠温度 ,分别记录加温前、食管温度 39℃、4 0℃、4 1℃、4 2℃、4 2℃ 1h、4 2℃ 2h与降温期 4 0℃、39℃、38℃时的血流动力学参数 ,对术中血压下降超过基础值的 30 %或心率 >130次 /min者 ,分别给予去甲肾上腺素和艾司洛尔处理 ,并记录各时段的药物使用总量。结果 :随着体温的升高 ,心率 (HR)、心脏指数 (CI)、中心静脉压 (CVP)、平均肺动脉压(MPAP)、肺毛细血管楔压 (PCWP)逐渐增加 ,HR ,CI,MPAP ,PCWP在 4 1℃时与加温前比分别增加了 5 5 % ,10 0 % ,18%和 4 9%。当体温 >4 1℃ ,CVP和平均主动脉压 (MAP)也开始出现非常显著的变化 ,此时HR常 >130次 /min ,MAP降低常超过基础值的 30 % ,需间断静注艾司洛尔和去甲肾上腺素予以控制。去甲肾上腺素用量在 4 2℃ 1h～ 4 2℃ 2h
Objective: To observe the changes of hemodynamics in patients with advanced cancer treated by intravenous venous shunts in vitro (VV PISH). Methods: Twenty-eight patients with advanced cancer, aged 29-73 years old, ASA Ⅰ ~ Ⅱ grade, had normal cardiopulmonary function before operation, no brain metastasis and large intravascular thrombosis. After induction of anesthesia, the radial artery and the right subclavian vein were punctured, and the cardiac function was monitored by placing the Swan Ganz catheter through the right internal jugular vein. Bilateral femoral vein percutaneous puncture into the femoral vein catheter, connected with an external thermotherapy machine (TEMETSYSTEM 100), the whole body after heparinization hot perfusion therapy. The esophageal and rectal temperatures were monitored during operation. The temperature of the esophagus was 39 ℃, 40 ℃, 41 ℃, 42 ℃, 42 ℃ 1h, 42 ℃ 2h, 40 ℃, 39 ℃ , Hemodynamic parameters at 38 ℃, intraoperative blood pressure dropped more than 30% of the baseline value or heart rate> 130 beats / min were given norepinephrine and esmolol treatment, and record the time of the drug Total usage. Results: Heart rate (HR), heart index (CI), CVP, MPAP and PCWP increased with the increase of body temperature. HR, CI, MPAP , Respectively. PCWP increased 5 5%, 10 0%, 18% and 49% respectively at 4 1 ℃ and before warming. When body temperature> 4 1 ℃, CVP and mean aortic pressure (MAP) also began to show a very significant change, this time HR often> 130 beats / min, MAP decreased often exceed the basal value of 30% Lol and norepinephrine to be controlled. Norepinephrine dosage at 4 2 ℃ 1h ~ 4 2 ℃ 2h