Uloga Swan-Ganz PA katetera u proceni hemodinamskih promena tokom hirurske revaskularizacije miokarda u bolesnika sa oslabljenom funkcijom leve komore

Abstract

Coronary artery bypass surgery in patient with bad left ventricular function is a challenge for surgical time. Specially important is monitoring of haemodynamics. We performed this open, prospective, randomized study with the aim to assess haemodynamics and oxygen profile monitoring. 34 pts for coronary surgery (EF < 40%) were divided in two groups. Group A, 17 pts. Received glucose-insulin-potassium (GIK) solution. Group B, 127 pts. Received Ringer solution. Haemodynamic and oxygen metabolism parameters were measured in four time points. I after the induction in anesthesia; II after the operation; III 6 hours post op.; IV 24 hour post op. Data are expressed as mean +/-SD, ANOVA for repeated measures followed by Newman-Keuls testing were used. In both groups were evident deterioration of cardiac function during first 6h as well as VO2 and DO:, more prominent in Group B. Significant recovery and improvement of cardiac function were evident in Group A after 24 h. CI during the time in Group A improves significantly (2.14+/-0.36 v. 3.05+/-0.55; p=0.0002) and difference during the time between groups was p=0,005. LVSWI improved significantly during the time him Group A (AIII vs. AIV) p=0.007. Simultaneously. VO improves significantly in Group A (103+/-21 vs. 164+/-30, p=0.00001) while difference between groups in DO was p=0.037. Importance of oxygen metabolism monitoring for both, left ventricular function and haemodynamics assessment was evident in our study.