国际麻醉学与复苏杂志   2016, Issue (4): 0-0
    
婴幼儿心脏手术体外循环前并行期间降温速度对 血乳酸值变化的影响
钟超超1()
1.徐州医学院附属医院
The influence of cooling rate to blood lactate levels during the pre-parallel bypass period of cardio-pulmonary bypass in infants who were undergoing cardiac surgery
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摘要:

目的 通过回顾性资料的分析,探讨婴幼儿先天性心脏病手术CPB前并行期间血乳酸(lactic acid, Lac)水平变化与降温速度之间的关系。 方法 先天性心脏病手术患儿44例,性别不限,年龄≤5岁。于麻醉诱导后、阻断升主动脉后取桡动脉血2 ml,测定Lac浓度、动脉血氧分压(oxygen partial pressure, PaO2)、Hb,记录患儿的MAP、体表面积、CPB预充的胶体量、晶体量、5%NaHCO3量、阻断升主动脉时鼻咽温、从降温到阻断升主动脉所用时间,同时计算出Lac变化量、降温速率。将Lac变化量≥0.5 mmol/L的患儿分为A组,将Lac变化量<0.5 mmol/L的患儿分为B组,每组22例。 结果 采用Logistic回归分析发现,Lac变化量与降温速度相关度较高( OR=3.85, P<0.05),与其他指标无明显相关性。继而采取t检验分析发现两组的Lac均较麻醉诱导后升高,A组为(0.8±0.3) mmol/L 比 (1.8±0.4) mmol/L(P<0.05); B组为(0.9±0.4) mmol/L 比 (1.4±0.9) mmol/L(P<0.05),A组升高较B组明显,为(0.8±0.4) mmol/L 比 (0.3±0.1) mmol/L(P<0.05),而B组的降温速度大于A组,为(0.9±0.2) ℃/min 比 (0.5±0.2) ℃/min(P<0.05),其他因素两组间差异无统计学意义(P>0.05)。 结论 CPB前并行期间,在水温与血液温差允许的范围内,增加降温速度可以抑制此阶段Lac的升高水平。

关键词: 婴幼儿; 体外循环; 前并行; 乳酸; 降温速度
Abstract:

Objective To investigate the relationship between blood lactic acid(Lac) and cooling rate during the pre-parallel bypass period in infants undergoing cardiac surgery. Methods Forty four infants with congenital disease, no limit on the gender, no more than 5 years old. After anesthesia induction and clamping the ascending aorta, respectively collecting 2 ml of radial artery blood to conduct blood gas analysis. Measuring the Lac level, oxygen partial pressure(PaO2), Hb, and also recording MAP, body surface area, the amount of colloidal liquid and crystal liquid in priming fluid, nasopharyngeal temperature when clamping the ascending aorta, the time from cooling to clampingthe ascending aorta. Calculating the change of Lac level and cooling rate. Considering the balance between groups, divided the patients into two groups according to the change of Lac level, group A(≥0.5 mmol/L) and group B(<0.5 mmol/L)(n=22). Results According to the results of t-test, Lac value of both groups are increased after anesthesia induction and a significant rise in group A than in group B, group A was (0.8±0.3) mmol/L vs (1.8±0.4) mmol/L(P<0.05), group B was(0.9±0.4) mmol/L vs (1.4±0.9) mmol/L(P<0.05), while the cooling rate of group A is slower than that in group B[(0.9±0.2) ℃/min vs (0.5±0.2) ℃/min](P<0.05). Other factors have no statistical difference between the two groups. Conclusions The pre-parallel bypass period of extracorporeal circulation, to the extent permitted temperature difference between blood and water, increasing the cooling rate can inhibit the rise of lactic acid level in this stage.

Key words: Infant;  Extracorporeal circulation; Pre-parallel; Lactic acid; Cooling rate