婴幼儿法洛四联症体外循环手术降温期不同血气管理的分析  

The analysis on different blood gas management during hypothermic period of cardiopulmonary bypass in infants with tetralogy of fallot

作　　者：胡英超[1] 王雪芹[1] 陈莉莉 朱筱珊[1] 丁力[1] 

机构地区：[1]安徽省立儿童医院心胸外科体外循环组,合肥230051

出　　处：《安徽医学》2009年第4期408-410,共3页Anhui Medical Journal

摘　　要：目的探讨婴幼儿法洛四联症(TOF)体外循环(CPB)手术降温期间两种血气管理方法中PH稳态的优越性。方法40例3岁以下TOF患儿,随机分为A、B两组,每组20例,在低温CPB下行TOF纠治术。两组病例在CPB降温期间采取不同的血气管理,A组采取a稳态(a-stat)血气管理,B组采用PH稳态(PH-stat)血气管理。结果体温降至30～28℃时测定动脉血气:A组血标本采取37℃常温(a稳态)血气检测,B组血样本分别进行常温和矫正温度(PH稳态)血气检测。结果显示:A、B组降温期a稳态血气测定值基本接近血气正常值pH7.40(7.35～7.45)、PCO240(35～45)mmHg左右,两组间对应血气数值比较差异无统计学意义(P>0.05);而B组降温期PH稳态血气检验值pH7.58±0.07明显高于A组a稳态血气测定值pH7.37±0.05,PCO2(24.95±3.88)mmHg则明显低于A组PCO2(45.2±4.93)mmHg,对应血气数据t检验差异有统计学意义(P<0.001)。降温期间对B组进行PH稳态血气管理,通过调节气体流量降低膜肺气/血比的方法增加血液CO2含量提高PCO2,使其血气分析指标在PH稳态下达到正常值pH7.40、PCO240mmHg左右。因此,降温期间采取PH稳态血气管理实际上增加了血液中的CO2含量。结论婴幼儿TOF低温体外循环手术降温期采用PH稳态血气管理能增加血液中CO2含量有利于脑保护。Objective To analyze the advantage of PH-stat blood gas management on cerebral protection effect during hypothermic cardiopulmonary bypass （CPB） in infants with Tetralogy of Fallot （TOF）. Methods 40 infants with TOF,aged under three years,undergoing corrective procedure were randomly divided into A group （a-star strategy,n=20） and B group （PH-stat strategy,n=20） during the hypothermic period of eardiopulmonary bypass. Results The arterial blood gas analyses were carried out in group A at normal temperature 37℃（a-stat） and group B at corrective temperature （PH-tsat） respectively.The outcome showed that the PH7.5±0.07 of PH-stat for B was obviously higher than the PH7.37±0.05 of a-stat for A,and the PCO224.95±3.88mmHg of B apparently lower than the PCO245.2±4.93mmHg of A.Significant difference was found in the blood gas analysis results between the two group with different blood gas management（P〈0.001）. Conclusinons The PH-stat blood gas management has advantages to cerebral protection by increasing CO2 content of blood during hypothermic period of eardiopulmonary bypass in infants with Tetralogy of Fallot.

关 键 词：婴幼儿 体外循环 PH稳态血气管理 脑保护 

分 类 号：R726.5[医药卫生—儿科]