低温体外循环术后体温变化对血乳酸及氧代谢的影响  

Effects of body temperature change on the level of lactic acid and oxygen metabolism after the hypothermic cardiopulmonary bypass （CPB）

作　　者：张继芝[1] 彭玉兰[2] 秦卫华[3] 

机构地区：[1]山东省聊城市第二人民医院心胸外科,252600 [2]山东省聊城市第二人民医院两腺外科,252600 [3]山东省聊城市第二人民医院危重病科,252600

出　　处：《中华现代护理杂志》2009年第27期2724-2726,共3页Chinese Journal of Modern Nursing

基　　金：基金项目：聊城市科技攻关项目（20070405）

摘　　要：目的探讨低温体外循环心脏术后复温过程中体温变化对血乳酸水平及氧代谢的影响，为合理控制患者体温提供依据。方法对60例低温体外循环心脏术后患者进行监测，分别在肛温37，37．5，38，38．5℃时采集动、静脉血标本，检测动静脉血氧代谢及血乳酸值。结果复温时全身的氧耗量明显增加；动脉血乳酸值在肛温37．5℃时最接近正常，37，38℃时次之，肛温38．5℃时血乳酸值最高（高乳酸血症），差异有统计学意义。结论在低温体外循环心脏术后复温过程中，体温变化是影响氧耗量和血乳酸水平的重要因素，护理人员应将患者体温控制在37．5℃左右的安全范围内。Objective To investigate the effects of body temperature change on the level of arterial blood lactic acid and oxygen metabolism after the hypothermic cardiopulmonary bypass （ CPB）, and to provide a basis for＇controlling body temperature of patients. Methods 60 patients performed the open cardiac operation under hypothermic cardiopulmonary bypass were monitored. The arterial and mixed venous blood gas, and the level of lactic acid were measured at four different rectal temperatures： 37,37.5,38 ℃ and 38.5 ℃, by taking samples of arterial and venous bloods. Results The systemic arterial-venous oxygen content and oxygen extraction were increased during rewarming time. The level of arterial blood lactic acid at the rectal temperature of 37. 5℃ mostly approachs the normal value, next is at the rectal temperature of 37 ℃ and 38 ℃, respectively. And the level of arterial blood lactic acid at the rectal temperature of 38.5 ℃ is the highest （hyperlactacidemia）. The difference shows a statistically significance. Conclusions During the rewarming process after the hypothermic cardiopulmonary bypass （CPB）, the body temperature change is a key factor influencing oxygen extraction and blood lactic acid level. The nursing staff should control the body temperature of patients with the safe range of around 37.5 ℃.

关 键 词：体外循环 体温调节 血乳酸 氧耗量 护理 

分 类 号：R473.6[医药卫生—护理学]