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心肺转流不同血压对灌注效果影响的研究

郭珊1,薛玉良2,王中2   

  1. 1. 泰达国际心血管病医院
    2. 泰达国际心血管病医院手术部麻醉科
  • 收稿日期:2011-04-02 修回日期:2011-06-02 出版日期:2012-02-15 发布日期:2012-02-15
  • 通讯作者: 郭珊

Clinical study on influence of different blood pressure to perfusion in extracorporeal circulation.

  • Received:2011-04-02 Revised:2011-06-02 Published:2012-02-15 Online:2012-02-15

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摘要： [摘要] 目的 探讨血压对SvO2、Lac值变化的影响。方法 选择择期CABG手术患者40例，随机分为两组，I组在ECC期间用血管活性药将平均动脉压调控在60～90mmHg，II组ECC期间平均动脉压在40～60mmHg。两组均于ECC前即刻（T1）、ECC阻断5分钟(T2)、复温前即刻(T3)、停止ECC前即刻(T4)、转入重症监护室(ICU)前即刻(T5) 5个点抽取动脉和静脉血气，根据血气结果调整红细胞比容（Hct）、吸入氧浓度（Pao2）、血糖及各离子在生理范围内，记录SVO2及Lac值以及各点的温度。结果 1. 两组患者的一般资料、ECC临床资料、血气测定结果差异无统计学意义（P>0.05）。 2. 两组患者Svo2组间比较各时点差异无统计学意义。 3. 两组患者Lac值组间比较：T4、T5两点 II组Lac值显著高于I组（P<0.05）。结论：体外循环期间适当应用血管活性药调节动脉平均压不低于60mmHg有利于降低Lac值，提示组织灌注效果优于等流量低压灌注。

关键词: 血压, 体外循环, 冠状动脉旁路移植术, 混合静脉血氧饱和度, 乳酸

Abstract: [Abstract] OBJECTIVE To explore the influence of different blood pressure in mixed venous oxygen saturation(SvO2) and lactic acid(Lac). METHODS Forty patients undergoing coronary artery bypass graft(CABG) surgery with extracorporeal circulation(ECC) were selected and divided randomly into two groups: the patients in group I were applied with drugs to keep blood pressure between 60 and 90mmHg duringECC. Those in group II were to keep blood pressure between 40 and 60mmHg. The arterial and venous blood gas were examined at time points of before extracorporeal circulation(T1), five minutes after clamping the ascending aorta (T2), before rewarming (T3), before the end of ECC (T4) and before delivering (T5). Hematocrit, arterial oxygen saturation and glucose, and electrolytes were maintained within the normal range during ECC. The values of SvO, Lac and temperature at all time points were recorded. RESULTS 1. The normal data, ECC clinical data and the result of blood gas had no significant statistical. differences between the two groups(P>0.05). 2. There were no significant statistical differences in SvO2 of the two groups. 3. There were significant statistical difference in Lac of the two groups with point T4 and T5: the results of Lac in group II were higher than in group I (P<0.05). CONCLUSION Maintenance of a higher blood pressure with vasoactive drugs during extracorporeal circulation is favorable to decrease the blood lac after rebeating.

Key words: blood pressure, Extracorporeal circulation, coronary artery bypass graftinging, mixed venous oxygen saturation, lactic acid