国际麻醉学与复苏杂志   2013, Issue (7): 7-7
    
静动脉二氧化碳分压差在冠状动脉旁路移植术围术期心输出量评估中的应用观察
袁辉, 祁明1()
1.武汉亚洲心脏病医院
Observation of Carbon dioxide partial pressure of arterial-venous difference to evaluate the CO in the C ABG patients perioperatively
 全文:
摘要：

[ 摘要 ] 目的：探讨经过术后上腔静脉血氧饱和度 (ScvO2)>70% 的CABG患者是否能够应用静动脉二氧化碳分压差 (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% 的冠状动脉旁路移植术(CABG)患者，根据术后即刻静动脉二氧化碳分压差 (Pcv-aCO2) 是否≥ 6mmHg，分为高 Pcv-aCO2 组和低Pcv-aCO2 组。观察 2 组患者在术后0h；8h；12h；24h；48h 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(Lac) 、心指数（CI）、血管活性药物评分分别为3.7±1.3 mmol/L、3.54±0.88L/m2、9±5分，高 Pcv-aCO2 组动脉血乳酸(Lac) 、心指数（CI）、血管活性药物评分分别为6.5±2.5mmol/L、2.79±0.68 L/m2、13±.6分，两组比较有明显统计学意义(P <0.05)。两组患者入组后均在术后8h出现心指数下降，lac及血管活性药物评分上升，低Pcv-aCO2 组在术后第12h、24h、48h心指数逐渐上升，lac及血管活性药物评分下降；高Pcv-aCO2 组在术后第24h才出现心指数逐渐上升，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 Pcv-aCO2 组(P <0.05)。 低Pcv-aCO2 组IABP应用率为3.8%、呼吸机辅助时间为34±22h、住ICU时间为106±26h、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±27h、住ICU时间为136±45h、呼吸衰竭发生率17.2%、肾功能衰竭发生率1.3%,，两组比较有明显统计学意义(P <0.05)。结论： CABG患者术后早期Pcv-aCO2 ≥ 6 mmHg提示心排量不足，术后并发症的发生与早期高Pcv-aCO2水平有明显关系。
关键词： 冠状动脉旁路移植术 心脏外科手术 血流动力学 静脉二氧化碳分压；上腔静脉血氧饱和度；
Abstract:

Abstract AIM：To evaluate the central venous atrial carbon dioxide gradient (Pcv-aCO2) as a effective index of perioperativecardiac out-put for the undergoing CABG (coronary artery bypass graft) patients with a central venous oxygen saturation (ScvO2)> 70%. METHODS：142 patients who suffered early ScvO2> 70% after CABG were divided by immediate Pcv-aCO2(threshold of 6 mmHg). All parameters of the high Pcv-aCO2 group(64 cases) and low Pcv-aCO2 group (78 cases) including hemodynamic, perfusion index, cardiac status, recovery situation were observed and collected postoperatively at the point of 0h,8h; 12h; 24h; 48h; RESULTS：the parameters of the predictors such as arterial lactate , CI and vasoactive score are 3.7±1.3 mmol/L、3.54±0.88L/m2、9±5 respectively in the low Pcv-aCO2 group,while the figures are 6.5±2.5mmol/L、2.79±0.68 L/m2、13±.6 respectively in the high Pcv-aCO2 group, with an obviously different comparision between the two group(P <0.05), which in details shows that there is a trend of CI declineing, lactate score soaring and the vasoactive drug aplication increasing in both group at the first 8h postoperatively, yet the CI increases, the lactate and the vasoactive deduct on the postoperative hour 12,24,48 in the low Pcv-aCO2 group ,compared with the trend turning up on the postoperative hour 24 in the high Pcv-aCO2 group. CI in low Pcv-aCO2 group was significantly higher than the high Pcv-aCO2 group (P <0.05).Lactate, and vasoactive drug administration in the former group decreased rapidly compared with the latter. The low Pcv-aCO2 group shows great advantages in the indexes including the application rate of IABP(3.8%), mechanical ventilation time(34±22h), ICU stay length(106±26h) ,postoperative respiratory failure incidence complications(5.1%) and the renal failres incidence (1.3%), while the parameters is obviously higher in the high Pcv-aCO2 group, which are 12.5%, 48±27h, 136±45h, 17.2% and 1.3% respectively ,with a P <0.05; .CONCLUSION： early Pcv-aCO2 ≥ 6 mmHg, as a poor outcome predictor, suggested lack of effective circulating blood flow ,therefore there is significant relationship between the occurrence of postoperative complications and early high level of Pcv-aCO2
Key words: coronary artery bypass grafting ,cardiac surgery; hemodynamic; venous partial pressure of carbon dioxide; oxygen saturation of superior vena cava;