rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2005-6-70-79rmt-1214Research ArticleОБЗОРЫ И КРАТКИЕ СООБЩЕНИЯREVIEWS & SHORT COMMUNICATIONSПрименение волюметрического мониторинга на основе транспульмональной термодилюции при кардиохирургических вмешательствахUse of Transpulmonary Thermodilution-based Volumetric Monitoring During Cardiosurgical InterventionsКировМ. Ю.KirovM. Yu.ЛенькинА. И.LenkinA. I.КузьковВ. В.KuzkovV. V.Кафедра анестезиологии и реаниматологии Северного государственного медицинского университета, АрхангельскDepartment of Anesthesiology and Reanimatology, North State Medical University, Arkhangelsk20052012200516Том I № 6 2005 г.7079Copyright © Киров М.Ю., Ленькин А.И., Кузьков В.В., 20052005Киров М.Ю., Ленькин А.И., Кузьков В.В.Kirov M.Y., Lenkin A.I., Kuzkov V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/1214

Цель обзора — представление современной информации об использовании нового вида волюметрического мониторинга гемодинамики, транспульмональной термодилюции, в кардиохирургии.

Материалы и методы

Материалы и методы. Анализ отечественных и зарубежных источников медицинской литературы по данной проблеме.

Результаты

Результаты. В течение последних лет метод транспульмональной термодилюции стал активно использоваться в современной анестезиологии и реаниматологии, в том числе при операциях аортокоронарного шунтирования, коррекции пороков и трансплантации сердца. Показатели, полученные с помощью транспульмональной термодилюции, коррелируют с результатами других методов мониторинга и позволяют расширить возможности диагностики нарушений системной и легочной гемодинамики. Внедрение лечебных алгоритмов, основанных на результатах волюметрического мониторинга, дает возможность целенаправленно проводить интенсивную терапию кардиохирургических пациентов (инфузионная нагрузка, инотропная и вазопрессорная поддержка, назначение диуретиков), что может улучшить клинический исход.

Заключение

Заключение. Применение в кардиохирургии волюметрического мониторинга на основе транспульмональной тер-модилюции обеспечивает адекватный контроль показателей преднагрузки, сократимости миокарда, легочного кровообращения и сосудистого тонуса, что позволяет выработать дифференцированный подход к коррекции гемодинамики в периоперационном периоде.

Objective

Objective. To present currently available information on the use of transpulmonary thermodilution, a new type of volumetric monitoring of hemodynamics.

Materials and methods

Materials and methods. The data available in the Russian and foreign medical literature on this problem are analyzed.

Results

Results. In the past recent years, transpulmonary thermodilution has come into wide use in modern anesthesiology and reanimatology, including during aortocoronary bypass surgery, correction of cardiac defects, and cardiac transplantation. The values obtained by transpulmonary thermodilution correlate with the results of other monitoring methods and can extend the capabilities of diagnosis of systemic and pulmonary hemodynamic disorders. The introduction of therapeutic algorithms based on the results of volumetric monitoring makes it possible to perform intensive therapy of cardio-surgical patients purposefully (infusion load, inotropic and vasopressor support, use of diuretics), which can improve a clinical outcome.

Conclusion

Conclusion. The use of transpulmonary thermodilution-based volumetric monitoring during cardiosurgical interventions assures adequate control of the values of preload, myocardial contractility, pulmonary circulation, and vascular tone, which allows one to develop a differential approach to correcting hemodynamics in the perioperative period.

ReferencesРубинчик В. Е., Курапеев И. С., Наймушин А. В. и др. Особенности гемодинамики при операциях коронарного шунтирования на работающем сердце. Анестезиология и реаниматология 2005; 2: 44—49.Рубинчик В. Е., Курапеев И. С., Наймушин А. В. и др. Особенности гемодинамики при операциях коронарного шунтирования на работающем сердце. Анестезиология и реаниматология 2005; 2: 44—49.Branca P., McGaw P., Light R. et. al. Factors associated with prolonged mechanical ventilation following coronary artery bypass surgery. Chest 2001; 2: 119.Branca P., McGaw P., Light R. et. al. Factors associated with prolonged mechanical ventilation following coronary artery bypass surgery. Chest 2001; 2: 119.Kamming D., Davis W. Thoracic epidural analgesia for coronary artery surgery. A bridge too far? Eur. J. Anaesthesiol. 2005; 22: 85—88.Kamming D., Davis W. Thoracic epidural analgesia for coronary artery surgery. A bridge too far? Eur. J. Anaesthesiol. 2005; 22: 85—88.Ngaage D. L. Off-pump coronary artery bypass grafting: the myth, the logic and the science. Eur. J. Cardiothorac. Surg. 2003; 24: 557—570.Ngaage D. L. Off-pump coronary artery bypass grafting: the myth, the logic and the science. Eur. J. Cardiothorac. Surg. 2003; 24: 557—570.Chassot P. G., van der Linden P., Zaugg M. et al. Off-pump coronary artery bypass surgery: physiology and anaesthetic management. Br. J. Anaesth. 2004; 92 (3): 400—413.Chassot P. G., van der Linden P., Zaugg M. et al. Off-pump coronary artery bypass surgery: physiology and anaesthetic management. Br. J. Anaesth. 2004; 92 (3): 400—413.Higgins M. J., Hickey S. Anesthetic and perioperative management in coronary surgery. In: Surgery of coronary artery disease / ed. Wheatley DJ. Arnold. L. 2003: 135—156.Higgins M. J., Hickey S. Anesthetic and perioperative management in coronary surgery. In: Surgery of coronary artery disease / ed. Wheatley DJ. Arnold. L. 2003: 135—156.Perrino A. C., Harris S. N., Luther M. A. Intraoperative determination of cardiac output using multiplane transesophageal echocardiography: a comparison to termodilution. Anesthesiology 1998; 89: 350—357.Perrino A. C., Harris S. N., Luther M. A. Intraoperative determination of cardiac output using multiplane transesophageal echocardiography: a comparison to termodilution. Anesthesiology 1998; 89: 350—357.Arisa M., Gothard J. W., Macnaughton P. et al. Blood lactate and mixed venous-arterial PCO 2 gradient as indices of poor peripheral perfusion following cardiopulmonary bypass surgery. Intens. Care Med. 1991; 17: 320—324.Arisa M., Gothard J. W., Macnaughton P. et al. Blood lactate and mixed venous-arterial PCO 2 gradient as indices of poor peripheral perfusion following cardiopulmonary bypass surgery. Intens. Care Med. 1991; 17: 320—324.Bailey J. M., Levy J. H., Kopel M. A. et al. Relationship between clinical evaluation of peripheral perfusion and global hemodynamics in adults after cardiac surgery. Crit. Care Med. 1990; 18: 1353—1356.Bailey J. M., Levy J. H., Kopel M. A. et al. Relationship between clinical evaluation of peripheral perfusion and global hemodynamics in adults after cardiac surgery. Crit. Care Med. 1990; 18: 1353—1356.Кузьков В. В., Киров М. Ю., Недашковский Э. В. Волюметрический мониторинг на основе транспульмональной термодилюции в анестезиологии и интенсивной терапии. Анестезиология и реаниматология 2003; 4: 67—73.Кузьков В. В., Киров М. Ю., Недашковский Э. В. Волюметрический мониторинг на основе транспульмональной термодилюции в анестезиологии и интенсивной терапии. Анестезиология и реаниматология 2003; 4: 67—73.Bernard G. R., Sopko G., Cerra F. et al. Pulmonary artery catheterization and clinical outcomes: National Heart, Lung, and Blood Institute and Food and Drug Administration Workshop Report. Consensus Statement. JAMA 2000; 283: 2568—2572.Bernard G. R., Sopko G., Cerra F. et al. Pulmonary artery catheterization and clinical outcomes: National Heart, Lung, and Blood Institute and Food and Drug Administration Workshop Report. Consensus Statement. JAMA 2000; 283: 2568—2572.Dalen J. E., Bone R. C. Is it time to pull the pulmonary artery catheter? JAMA 1996; 276: 916—918.Dalen J. E., Bone R. C. Is it time to pull the pulmonary artery catheter? JAMA 1996; 276: 916—918.Эйткенхед А. Р., Смит Г. Руководство по анестезиологии / под ред. Дамир Е. А. М: Медицина; 1999; 2. 386—388.Эйткенхед А. Р., Смит Г. Руководство по анестезиологии / под ред. Дамир Е. А. М: Медицина; 1999; 2. 386—388.Козлов И. А., Кричевский Л. А. Модифицированная транспульмональная термодилюция в кардиоанестезиологии и интенсивной терапии. Вестн. интенс. тер. 2004; 3: 36—40.Козлов И. А., Кричевский Л. А. Модифицированная транспульмональная термодилюция в кардиоанестезиологии и интенсивной терапии. Вестн. интенс. тер. 2004; 3: 36—40.Bindels A. J. G. H., van der Hoeven J. G., Meinders A. E. Pulmonary artery wedge pressure and extravascular lung water in patients with acute cardiogenic pulmonary edema requiring mechanical ventilation. Am. J. Cardiol. 1999; 84 (10): 1158—1163.Bindels A. J. G. H., van der Hoeven J. G., Meinders A. E. Pulmonary artery wedge pressure and extravascular lung water in patients with acute cardiogenic pulmonary edema requiring mechanical ventilation. Am. J. Cardiol. 1999; 84 (10): 1158—1163.Lichtwarck[Aschoff M., Zeravik J., Pfeiffer U. J. Intrathoracic blood volume accurately reflects circulatory volume status in critically ill patients with mechanical ventilation. Intens. Care Med. 1992; 18 (3): 137—138.Lichtwarck[Aschoff M., Zeravik J., Pfeiffer U. J. Intrathoracic blood volume accurately reflects circulatory volume status in critically ill patients with mechanical ventilation. Intens. Care Med. 1992; 18 (3): 137—138.Sakka S. G., Ruhl C. C., Pfeiffer U. J. et al. Assessment of cardiac preload and extravascular lung water by single transpulmonary thermodilution. Intens. Care Med. 2000; 26 (2): 180—187.Sakka S. G., Ruhl C. C., Pfeiffer U. J. et al. Assessment of cardiac preload and extravascular lung water by single transpulmonary thermodilution. Intens. Care Med. 2000; 26 (2): 180—187.Sakka S. G., Reinhart K., Meier[Hellmann A. Comparison of pulmonary artery and arterial thermodilution cardiac output in critically ill patients. Intens. Care Med. 1999; 25 (8): 843—846.Sakka S. G., Reinhart K., Meier[Hellmann A. Comparison of pulmonary artery and arterial thermodilution cardiac output in critically ill patients. Intens. Care Med. 1999; 25 (8): 843—846.Sakka S. G., Meier[Hellmann A. Yearbook of intensive care and emergency medicine / ed. J. L. Vincent. Berlin; 2000. 671—679.Sakka S. G., Meier[Hellmann A. Yearbook of intensive care and emergency medicine / ed. J. L. Vincent. Berlin; 2000. 671—679.Kirov M. Y., Kuzkov V. V., Lenkin A. I. et al. Single transpulmonary thermodilution during off-pump coronary artery bypass grafting. Eur. J. Anaesthesiol. 2005; 22 (suppl 34): 19—20.Kirov M. Y., Kuzkov V. V., Lenkin A. I. et al. Single transpulmonary thermodilution during off-pump coronary artery bypass grafting. Eur. J. Anaesthesiol. 2005; 22 (suppl 34): 19—20.Buhre W., Weyland A., Kazmaier S. et al. Comparison of cardiac output assessed by pulse-contour analysis and thermodilution in patients undergoing minimally invasive direct coronary artery bypass grafting. J. Cardiothorac. Vasc. Anesth. 1999; 13 (4): 437—440.Buhre W., Weyland A., Kazmaier S. et al. Comparison of cardiac output assessed by pulse-contour analysis and thermodilution in patients undergoing minimally invasive direct coronary artery bypass grafting. J. Cardiothorac. Vasc. Anesth. 1999; 13 (4): 437—440.Godje O., Peyerl M., Seebauer T. et al. Central venous pressure, pulmonary capillary wedge pressure and intrathoracic blood volumes as preload indicators in cardiac surgery patients. Eur. J. Cardiothorac. Surg. 1998; 13 (5): 533—539.Godje O., Peyerl M., Seebauer T. et al. Central venous pressure, pulmonary capillary wedge pressure and intrathoracic blood volumes as preload indicators in cardiac surgery patients. Eur. J. Cardiothorac. Surg. 1998; 13 (5): 533—539.Киров М. Ю., Кузьков В. В., Суборов Е. В. и др. Транспульмональная термодилюция и волюметрический мониторинг в отделении анестезиологии, реанимации и интенсивной терапии: Метод. рекомендации. Архангельск: СГМУ; 2004.Киров М. Ю., Кузьков В. В., Суборов Е. В. и др. Транспульмональная термодилюция и волюметрический мониторинг в отделении анестезиологии, реанимации и интенсивной терапии: Метод. рекомендации. Архангельск: СГМУ; 2004.Polanczyk C. A., Rohde L. E., Goldman L., et al. Right heart catheterization and cardiac complications in patients undergoing noncardiac surgery: an observational study. JAMA 2001; 286 (3): 309—314.Polanczyk C. A., Rohde L. E., Goldman L., et al. Right heart catheterization and cardiac complications in patients undergoing noncardiac surgery: an observational study. JAMA 2001; 286 (3): 309—314.Bindels A. J., van der Hoeven J. G., Meinders A. E. Pulmonary artery wedge pressure and extravascular lung water in patients with acute cardiogenic pulmonary edema requiring mechanical ventilation. Am. J. Cardiol. 1999; 84 (10): 1158—1163.Bindels A. J., van der Hoeven J. G., Meinders A. E. Pulmonary artery wedge pressure and extravascular lung water in patients with acute cardiogenic pulmonary edema requiring mechanical ventilation. Am. J. Cardiol. 1999; 84 (10): 1158—1163.Gray B. A., Beckett R. C., Allison R. C. et al. Effect of edema and hemodynamic changes on extravascular thermal volume of the lung. Appl. Physiol. 1984; 56 (4): 878—890.Gray B. A., Beckett R. C., Allison R. C. et al. Effect of edema and hemodynamic changes on extravascular thermal volume of the lung. Appl. Physiol. 1984; 56 (4): 878—890.Sakka S. G., Reinhart K., Meier[Hellman A. Comparison of pulmonary artery and arterial thermodilution cardiac output in critically ill patients. Intens. Care Med. 1999; 25 (8): 843—846.Sakka S. G., Reinhart K., Meier[Hellman A. Comparison of pulmonary artery and arterial thermodilution cardiac output in critically ill patients. Intens. Care Med. 1999; 25 (8): 843—846.Mitchell J. P., Schuller D., Calandrino F. S. et al. Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization. Am. Rev. Respir. Dis. 1992; 145 (5): 990—998.Mitchell J. P., Schuller D., Calandrino F. S. et al. Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization. Am. Rev. Respir. Dis. 1992; 145 (5): 990—998.Godje O., Hoeke K., Lamm P. et al. Continuous, less invasive, hemodynamic monitoring in intensive care after cardiac surgery. Thorac. Cardiovasc. Surg. 1998; 46 (4): 242—249.Godje O., Hoeke K., Lamm P. et al. Continuous, less invasive, hemodynamic monitoring in intensive care after cardiac surgery. Thorac. Cardiovasc. Surg. 1998; 46 (4): 242—249.Lichtwarck[Aschoff M., Beale R., Pfeiffer U. J. Central venous pressure, pulmonary artery occlusion pressure, intrathoracic blood volume, and right ventricular end-diastolic volume as indicators of cardiac preload. J. Crit. Care 1996; 11(4): 180—188.Lichtwarck[Aschoff M., Beale R., Pfeiffer U. J. Central venous pressure, pulmonary artery occlusion pressure, intrathoracic blood volume, and right ventricular end-diastolic volume as indicators of cardiac preload. J. Crit. Care 1996; 11(4): 180—188.Lichtwarck[Aschoff M., Leicht S., Kisch H. W. et al. Monitoring of right ventricular function using a conventional slow response thermistor catheter. Intens. Care Med. 1994; 20 (5): 348—353.Lichtwarck[Aschoff M., Leicht S., Kisch H. W. et al. Monitoring of right ventricular function using a conventional slow response thermistor catheter. Intens. Care Med. 1994; 20 (5): 348—353.Buhre W., Weyland A., Schorn B. et al. Changes in central venous pressure and pulmonary capillary wedge pressure do not indicate changes in right and left heart volume in patients undergoing coronary artery bypass surgery. Eur. J. Anaesthesiol. 1999; 16 (1): 11—17.Buhre W., Weyland A., Schorn B. et al. Changes in central venous pressure and pulmonary capillary wedge pressure do not indicate changes in right and left heart volume in patients undergoing coronary artery bypass surgery. Eur. J. Anaesthesiol. 1999; 16 (1): 11—17.Rex S., Brose S., Metzelder S. et al. Prediction of fluid responsiveness in patients during cardiac surgery. Br. J. Anaesth. 2004; 93 (6): 782—788.Rex S., Brose S., Metzelder S. et al. Prediction of fluid responsiveness in patients during cardiac surgery. Br. J. Anaesth. 2004; 93 (6): 782—788.Godje O., Seebauer T. et al. Hemodynamic monitoring by double-indicator dilution technique in patients after orthotopic heart transplantation. Chest 2000; 118 (3): 775—781.Godje O., Seebauer T. et al. Hemodynamic monitoring by double-indicator dilution technique in patients after orthotopic heart transplantation. Chest 2000; 118 (3): 775—781.Gust R., Gottschalk A., Bauer H. et al. Cardiac output measurement by transpulmonary versus conventional thermodilution technique in intensive care patients after coronary artery bypass grafting. J. Cardiothorac. Vasc. Anesth. 1998; 12 (5): 519—522.Gust R., Gottschalk A., Bauer H. et al. Cardiac output measurement by transpulmonary versus conventional thermodilution technique in intensive care patients after coronary artery bypass grafting. J. Cardiothorac. Vasc. Anesth. 1998; 12 (5): 519—522.Zollner C., Haller M., Weis M. et al. Beat-to-beat measurement of cardiac output by intravascular pulse contour analysis: a prospective criterion standard study in patients after cardiac surgery. J. Cardiothorac. Vasc. Anesth. 2000; 14 (2): 125—129.Zollner C., Haller M., Weis M. et al. Beat-to-beat measurement of cardiac output by intravascular pulse contour analysis: a prospective criterion standard study in patients after cardiac surgery. J. Cardiothorac. Vasc. Anesth. 2000; 14 (2): 125—129.Bein B., Worthmann F., Tonner P. H. et al. Comparison of esophageal Doppler, pulse contour analysis, and real-time pulmonary artery thermodilution for the continuous measurement of cardiac output. J. Cardiothorac. Vasc. Anesth. 2004; 18 (2): 185—189.Bein B., Worthmann F., Tonner P. H. et al. Comparison of esophageal Doppler, pulse contour analysis, and real-time pulmonary artery thermodilution for the continuous measurement of cardiac output. J. Cardiothorac. Vasc. Anesth. 2004; 18 (2): 185—189.Mahajan A., Shabanie A., Turner J. et al. Pulse contour analysis for cardiac output monitoring in cardiac surgery for congenital heart disease. Anesth. Analg. 2003; 97 (5): 1283—1288.Mahajan A., Shabanie A., Turner J. et al. Pulse contour analysis for cardiac output monitoring in cardiac surgery for congenital heart disease. Anesth. Analg. 2003; 97 (5): 1283—1288.Reuter D. A., Felbinger T. W., Schmidt C. et al. Stroke volume variations for assessment of cardiac responsiveness to volume loading in mechanically ventilated patients after cardiac surgery. Intens. Care Med. 2002; 28 (4): 392—398.Reuter D. A., Felbinger T. W., Schmidt C. et al. Stroke volume variations for assessment of cardiac responsiveness to volume loading in mechanically ventilated patients after cardiac surgery. Intens. Care Med. 2002; 28 (4): 392—398.Wiesenack C., Prasser C., Keyl C. et al. Assessment of intrathoracic blood volume as an indicator of cardiac preload: single transpulmonary thermodilution technique versus assessment of pressure preload parameters derived from a pulmonary artery catheter. J. Cardiothorac. Vasc. Anesth. 2001; 15 (5): 584—588.Wiesenack C., Prasser C., Keyl C. et al. Assessment of intrathoracic blood volume as an indicator of cardiac preload: single transpulmonary thermodilution technique versus assessment of pressure preload parameters derived from a pulmonary artery catheter. J. Cardiothorac. Vasc. Anesth. 2001; 15 (5): 584—588.Киров М. Ю., Кузьков В. В., Ленькин А. И. и др. Транспульмональная термодилюция при аорто-коронарном шунтировании на работающем сердце: В кн.: Тез. докл. 10 Всерос. съезда сердечно-сосудистых хирургов. М.; 2004. 232.Киров М. Ю., Кузьков В. В., Ленькин А. И. и др. Транспульмональная термодилюция при аорто-коронарном шунтировании на работающем сердце: В кн.: Тез. докл. 10 Всерос. съезда сердечно-сосудистых хирургов. М.; 2004. 232.Kwak Y. L., Oh Y. J., Jung S. M. et al. Change in right ventricular function during off-pump coronary artery bypass graft surgery. Eur. J. Cardiothorac. Surg. 2004; 25 (4): 572—577.Kwak Y. L., Oh Y. J., Jung S. M. et al. Change in right ventricular function during off-pump coronary artery bypass graft surgery. Eur. J. Cardiothorac. Surg. 2004; 25 (4): 572—577.Pauli C., Fakler U., Genz T. et al. Cardiac output determination in children: equivalence of the transpulmonary thermodilution method to the direct Fick principle. Intens. Care Med. 2002; 28 (7): 947—952.Pauli C., Fakler U., Genz T. et al. Cardiac output determination in children: equivalence of the transpulmonary thermodilution method to the direct Fick principle. Intens. Care Med. 2002; 28 (7): 947—952.

The authors declare that there are no conflicts of interest present.