Value of central venous-arterial carbon dioxide difference combined with stroke volume variation in guiding hemodynamic therapy during off-pump coronary artery bypass grafting
Yang Yanli
Qing Enming
Ma Jun
Abstract：Objective To evaluate the value of central venous-arterial carbon dioxide difference [P(cv-a) CO2] combined with stroke volume variation (SVV) in guiding hemodynamic therapy during off-pump coronary artery bypass grafting (OPCABG).Methods One hundred and twenty patients undergoing off-pump coronary artery bypass grafting were randomly assigned into P group (60 cases) given P(cv-a)CO2 combined with SVV-directed therapy,and C group (60 cases) given central venous pressure (CVP)-directed therapy.The heart rate(HR),mean arterial pressure (MAP),CVP,SVV,P(cv-a)CO2 and arterial blood lactate levels were monitored at the time of anesthesia induction (T0),the beginning of grafting (T1),30 min (T2),60 min (T3) and 90 min (T4) after the beginning of OPCABG and the end of the surgery (T5).The PaO2/FiO2 and fluid balance at the end of the surgery were recorded,and the recovery situation was observed.Results The level of arterial lactate was higher in C group than that in P group at T4 and T5 [(2.4 ± 0.5) mmol/L vs (1.3 ± 0.6) mmol/L,(2.9 ± 1.9) mmol/L vs (1.3 ± 0.8) mmol/L] (P ＜ 0.05).The fluid balance was significantly higher and the PaO2/FiO2 was significantly lower in C group than those in P group at the end of the surgery [(964±360) mlvs (413 ±210) ml,(310 ±58) vs (420 ±70)] (P＜0.05).P group showed great advantage in reducing ICU time,mechanical ventilation time,postoperative respiratory failure incidence and renal failure incidence compared with C group [(26±18) h vs (39 ±20) h,(51 ±31) h vs (76±24) h,1.6％ (1/60) vs 13.3 ％ (8/60),5.0％ (3/60) vs 16.7％ (10/60)] (P ＜ 0.05).Scores of the vasoactive-cardiotonic agents in P group was lower than that in C group[(2.0 ±0.8) scores vs (10.1 ±0.8) scores] (P ＜ 0.05).Conclusion P(cv-a) CO2 combined with SVV is superior to CVP in guiding the hemodynamic therapy for patients undergoing OPCABG.
Keywords：Coronary artery bypass,off-pumpCentral venous-arterial carbon dioxide differenceStroke volume variationHemodynamic therapy
Publication Date：2015-07-30
Online Publishing Date：2026-09-14(First online date of this platform, not the publication date of the document)
Pages：4( 971-974 )