全主动脉弓置换术患者体外循环深低温时高氧血气管理的效果  

Effect of hyperoxia management strategy during deep hypothermic cardiopulmonary bypass in patients undergoing total aortic arch replacement

作　　者：杨九光[1] 黄宇光[2] 龙村[1] 田良鑫[3] 鄂浩洁[4] 孙立忠[3] 

机构地区：[1]中国医学科学院中国协和医科大学阜外心血管病医院体外循环科,北京市100037 [2]北京协和医院麻醉科 [3]中国医学科学院中国协和医科大学阜外心血管病医院血管外科中心 [4]内蒙古包头市中心医院心脏外科

出　　处：《中华麻醉学杂志》2006年第1期11-15,共5页Chinese Journal of Anesthesiology

基　　金："十五"科技攻关项目基金资助项目(2001BA 705B10-7)

摘　　要：目的研究全主动脉弓置换术中患者体外循环(CPB)深低温时高氧血气管理的临床效果。方法 32例拟行全主动脉弓置换术患者随机分为常规血气管理组(常规组,16例)和高氧血气管理组(高氧组,16例)。CPB 术中分别采用常规血气管理及高氧血气管理方法。分别在切皮前、CPB 15 min、选择性脑灌注(SCP)10min、降主动脉开放5min、左锁骨下动脉开放5min、左颈总动脉开放5min、无名动脉开放5min、鼻咽温复温至35℃、CPB 停止10min 经颈静脉球及氧合器动脉端取血进行血气分析,检测颈静脉球血氧饱和度(SjvO_2)、血氧分压(PjvO_2)及 PaO_2。观察术后机械通气时间、苏醒时间、ICU 停留时间。手术前后进行神经系统物理检查、颅脑计算机体层摄影等检查。结果经调整混杂因子的多元线性回归分析,高氧组深低温期间 PaO_2与 PjvO_2呈显著独立正相关(B=0.129,SE= 0.045,P＜0.05)。高氧组有2例(12.5%),常规组有3例(18.75%)出现短暂性神经功能异常；与常规组比较,高氧组 CPB 中 SjvO_2、PjvO_2升高,术后苏醒时间、ICU 停留时间缩短。结论全主动脉弓替换术中 CPB 深低温期间采用高氧血气管理方法可提高溶解氧的供给,增加氧储备,临床预后较好。Objective To compare the effect of conventional and hyperoxia management strategy during deep hypothermia in patients with DeBake type 1 aortic dissection or aortic arch aneurysm undergoing total aortic arch replacement. Methods 32 adult patients undergoing total aortic arch replacement were randomly allocated to one of two groups （ n = 16 each） ： conventional （ C ） and hyperoxia group （ H ） . The patients had no history of cerebral vascular disease. Left radial artery and dorsal artery of left foot were cannulated for monitoring of blood pressure of upper and lower limbs. Right internal jugular vein was cannulated for CVP monitoring and administration of drug and fluid. Anesthesia was induced with etomidate 10-15 mg, fentanyl 5-10 μg· kg^-1 and pancuronium 0.1 mg· kg^-1 and maintained with fentanyl （total amount was 〈 20 μg· kg^-1）, isoflurane and pancuronium after tracheal intubafion. Intermittent i.v. boluses of diazepam, sodium thiopental or propofol were given during cardiopulmonary bypass （CPB）. Another catheter was inserted into right internal jugular vein cephalad until resistance was met. The tip of the catheter was at the level of mastoid process. The hyperoxia management involved the following steps： FiO2 was gradually reduced with decreasing body temperature （T0 ） from 70% （36 - 37℃） to 60%-40% （35.9-34℃）, 38%-30% （32-26℃）, 30% （26-24℃） and finally to 21% . When nasopharyngeal T0 was reduced to 22℃ or 5-10 min before selective cerebral perfusion （SCP）, FiO2 was raised to 60%-100% to maintain PjvO2 〉 20 mm Hg or SjvO2 〉 60% . FiO2 was maintained at 60%-100% during SCP until TO was rewarmed to 22℃, then reduced to 30% . FiO2 was then gradually increased to 40% （when To reached 28℃）, to 50%-70% （34-37℃） and finally to 80% （T0 〉 37℃）. Blood samples were taken from jugular venous bulb and arterial port of oxygenator for determination of PjvO2, SjvO2 and PaO2 before skin incision （T1）, at 15 min of CPB （T2）, 1

关 键 词：高氧 血气分析 心肺转流术 低温 全主动脉弓置换术 体外循环 高氧血气管理 

分 类 号：R654.1[医药卫生—外科学] R614[医药卫生—临床医学]