动静脉血pH和二氧化碳分压差监测组织氧合的实验研究  

Arterio venous pH and PCO 2 gradients in monitoring tissue oxygenation:Experimetal study

作　　者：蒋鸿鑫[1] 张岩[1] 

机构地区：[1]北京市首都医科大学附属北京友谊医院实验中心

出　　处：《中国危重病急救医学》1996年第4期195-200,共6页Chinese Critical Care Medicine

摘　　要：研究家兔（ｎ＝１０）急性失血过程中组织供氧量（ＤＯ２）、动脉混合静脉血（ＡＶ）ｐＨ和ＰＣＯ２差的关系，并与血乳酸浓度改变相比较。结果发现，随心输出量（Ｑ）降低，ＡＶｐＨ、ＡＶＨ＋、ＡＶＰＣＯ２进行性增大，血乳酸浓度逐渐升高。失血量和ＡＶｐＨ、ＡＶＨ＋、ＡＶＰＣＯ２以及血乳酸浓度呈双相关系，三者拐折点基本相同。因此，前期相当于“组织耗氧（ＶＯ２）不依赖ＤＯ２”期，即ＶＯ２不随ＤＯ２增减而改变；后期相当于“ＶＯ２依赖ＤＯ２”期，即ＶＯ２随ＤＯ２增减，拐折点相当于临界供氧量（ＤＯ２ｃｒｉｔ）。ＡＶｐＨ和ＡＶＰ－ＣＯ２突然增大提示“ＶＯ２依赖ＤＯ２，即组织缺氧的开始。提示：ＡＶｐＨ和ＡＶＰＣＯ２迅速增大主要与缺氧组织Ｈ＋和ＣＯ２生成增加有关。he purpose of this study was to evaluate the relationship between tissue oxygen delivery (O 2) and arteriovenous,pH and PCO 2 gradients(AVpH,AVPCO 2) in 10 rabbits during graded progressive hemorrhage.We compared the values of AVpH and AVPCO 2 with that of blood lactate in their relationship to changes in O 2.The results showed that AVpH,AVH +and AVPCO 2 increased progressively as cardiac output ( t)decreased,at the same time the blood lactate concentration increased.The relationship between cumulative blood loss,and AVpH,AVH +,AVPCO 2 and blood lactate concentration was biphasic:In the early stage of hemorrhage,AVpH,AVH + AVPCO 2 gradients and blood lactate concentration changed gradually and later these variables changed more rapidly.The inflection points in all cases were similar.Therefore,the first region represents O 2 supply independence,a condition in which O 2 consumption (O 2)does not vary with O 2,and the second region represents O 2 supply dependence,in which O 2 declines in proportion to O 2 and the inflection point corresponds to the critical O 2(O 2crit).Rapidly expanding AVpH and AVPCO 2 suggest the onset of O 2 supply dependence and represens reliable parameters of tissue hypoxina during hypoperfusion.

关 键 词：动-静脉血 组织缺氧 低灌注 二氧化碳分压差 

分 类 号：R602[医药卫生—外科学]