摘要
目的探讨经过术后上腔静脉血氧饱和度（central venous oxygen saturation，ScvO2）〉70％的冠状动脉旁路移植术（comnaxy artery bypass grafting，CABG）患者是否能够应用静动脉二氧化碳分压差（central venous atrial carbon dioxide partial pressure，Pcv-aCO2）作为围术期心输出量评估指标。方法142例术后早期ScvO2〉70％的CABG患者，根据术后即刻Pcv-aCO2是否≥6mmHg（1mmHg=0．133kPa），分为高Pcv-aCO2组和低Pcv-aCO2组。观察2组患者在术后即刻（T0）、8（T8）、12（T12）、24（T24）、48h（T48）时的血流动力学指标，灌注指标，心功能状态，恢复情况。结果64例患者为高Pcv-aCO2组，余78例患者为低Pcv-aCO2组。两组患者入组时低Pcv-aCO2组动脉血乳酸（lactate，Lac）、心指数（cardiac index，CI）、血管活性药物评分分别为（3．7±1．3）mm01]L、（3．54±0．88）lJm2,（9±5），高Pcv-aCO2组Lac、CI、血管潘陛药物评分分别为（6．5±2．5）mmol／L、（2.79±0．68）I／m^2、（13±6），两组比较差异有统计学意义（P〈0．05）。两组患者入组后均在术后8h出现CI下降，Lac及血管活性药物评分上升，低Pcv-aCO2组在T12、T24、T48时CI逐渐上升，Lac及血管活性药物评分下降；高Pcv-aCO2组在L时才出现CI逐渐上升，Lac及血管活性药物评分下降，低Pcv-aCO2组CI明显高于高Pcv-aCO2组（P〈0．05）；低Pcv-aCO2组Lac、血管活性药物评分下降时间早于高Pev-aCO2组（P〈0．05o低Pcv-aCO2组主动脉内球囊反搏（intra-aortic balloonpump，IABP）应用率为3．8％、呼吸机辅助时间为（34±22）h、住重症监护室（Icu）时间为（106±26）h、呼吸衰竭发生率5．1％、肾功能衰竭发生率1．3％，高Pcv-aCO2组IABP应用率为12．5％、呼吸机辅助时间为（48±27）h、住ICU时间为（136±45）h、呼吸衰竭发生率17．2％、肾功能衰竭发生率1．3％，两组比较差异有统计学意义（P〈0．05）�
Objective To investigate the central venous atrial carbon dioxide partial pressure （Pcv--aCO2）, as a effective index, perioperatively predicting cardiac out-put for the patients undergoing coronary artery bypass grafting （CABG） with central venous oxygen saturation（ScvO2）〉70%. Methods 142 patients underwent CABG suffering early ScvO2〉70% were divided into two groups by immediate Pcv-aCO2 （threshold of 6 mm Hg）（ 1 mm Hg=0.133 kPa）. All parameters, including hemodynamic, perfusion index, cardiac status, recovery situation were observed and collected postoperatively from the high Pcv-aCO2 group （64 cases） and low Pcv--aCO2 group（78 cases） at the very point of O（T0）, 8（Ts）, 12（T12）, 24（T24）, 48 h（T4s）. Results The parameters of the predictors such as arterial lactate （Lac） , CI and vasoaetive score were （3.7±1.3） mmol/L, （3.54±0.88） L/m2, （9±5） respectively in the low Pev-aCO2 group, while the figures were （6.5±2.5 ） mmol/L, （2.79±0.68） L/m2. （ 13 ＋6 ） correspondingly in the high Pcv-aCO2 group, with an obviously different comparison between the two group （P〈0.05）, which in details showed that both groups shared similar trend of CI decline, Lac score soaring and the vasoaetive drug application increase at the first 8 h postoperatively, and CI increased, the Lac and the vasoactive reduced on the postoperative hour T12, T24, T48 in the low Pcv-aCO2 group,while the tendency was turned up on the postoperative hour Tu in the high Pcv-aCO2 group. Concluding comparison showed that CI in low Pev-aCO2 group was significantly higher than the high Pev-aCO2 group （P〈0.05） , while Lac and vasoactive drug administration in the former group decreased rapidly compared with the latter. Besides, the low Pcv-aCO2 group showed great advantages in the indexes including the application rate of IABP（3.8%）, mechanical ventilation time（34±22） h, ICU stay length（106±26） h, postoperative respiratory failure incidence （5.1%） and
出处
《国际麻醉学与复苏杂志》
CAS
2013年第7期605-608,共4页
International Journal of Anesthesiology and Resuscitation
