混合静脉血氧饱和度评估心脏外科围术期的风险  

Effect of Mixed Venous Oxygen Saturation in Evaluation of Perioperative Risk in Cardiac Surgery

作　　者：江慧琦[1] 王萌[1] 华平[1] 王铭辉[1] 胡海宇[1] 杨艳旗[1] 

机构地区：[1]中山大学孙逸仙纪念医院心胸外科,广东广州510120

出　　处：《中山大学学报（医学科学版）》2012年第6期792-796,共5页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省自然科学基金(7001619);广东省科技计划项目(2007B050200011)

摘　　要：【目的】分析混合静脉血氧饱和度(SvO2)对心脏外科围术期风险评估的价值及其预警值。【方法】170例心脏手术后病人到达ICU时通过经胸壁肺动脉导管采取标本测量SvO2。分析SvO2与围术期危险因素以及预后的关系,运用统计学计算SvO2对术后并发症的预警值,并将预警值作为分组界值将病人分组进行比较,验证SvO2与心脏外科围术期并发症及预后的关系。【结果】SvO2的预警值为53.5%。A组(SvO2≤53.5%)22例;B组(SvO2>53.5%)148例。A组EuroSCORE(TheEuropean System for Cardiac Operative Risk Evaluation)评分(4.6±3.4)明显高于B组(2.8±2.3;P=0.015)。A组与B组相比,术后由于心包填塞或出血剖胸探查率18.18%vs 2.03%(P=0.006),术后脑梗死率13.6%vs 1.5%(P=0.016),术后第1天胶体液用量(1 587±732)mL vs(1 091±785)mL(P=0.002),住院死亡率18.18%vs 1.35%(P=0.003)等显著高于B组。4例(2.4%)发生频发室性早搏,拔除经胸壁肺动脉导管后心律失常消失。拔除经胸壁肺动脉导管后无一例发生导管相关出血。【结论】经胸壁肺动脉导管取血测量SvO2安全经济。SvO2对心脏外科围术期风险可做出可靠的评估。[ Objective ] Mixed venous oxygen saturation （SvO2） is often used in cardiac surgery to evaluate perioperative oxygen supply- and-demand balance and hemodynamic performance. The aim of the present study was to define a cutoff point of SvO2 to evaluate perioperative risks in cardiac surgery. [Method] One hundred and seventy patients underwent different cardiac surgery including AVR, MVR, CABG, double valve procedure, combined procedures, aortic surgery with circulation arrest, and acute CABG/valvular surgery. An epidural catheter was put intra-operatively through the chest wall and the anterior wall of the right ventricle into pulmonary artery as a trans-thoracic pulmonary artery catheter （TPAC） in all patients. SvO2 from TPAC on admission to ICU were analyzed in relation to NYHA classification, EuroSCORE, aortic clamping time, drain amount, colloid demand, postoperative stroke, length of ICU stay, and hospital mortality. A cutoff point of SvO2 was defined with ROC analysis. [ Result ] Lower SvO2 associated with higher mortality. The best cutoff point was 53.5%. The patients were divided into two groups according to the cutoff point： 22 patients with SvO2≤53.5% in group A and 148 patients with SvO2 〉53.5% in group B. EuroSCORE in group A （4.6 ± 3.4） was significantly higher than group B （2.8 ± 2.3 ; P = 0.015）, as was hospital mortality 18.18 % vs 1.35 % （P = 0.003）, reoperation for bleeding/tamponade 18.18 % vs 2.03% （P = 0.006）, postoperative stroke 13.6% vs 1.5% （P = 0.016）, and colloid demand in the first postoperative day （1587 ＋ 732）mL vs （1091 ± 785）mL （P = 0.002）. Four patients （2.4%） had in the first hours in ICU premature ventricular contraction which disappeared soon after TPAC was removed. No TPAC related bleeding was found after removal of the catheter. [ Conclusion ] SvO2 can be used quantitatively to evaluate perioperative risks in a mixed cardiac surgery population and showed good correspondence with EuroSCORE. TPAC is a safe and inexpensive me

关 键 词：混合静脉血氧饱和度 经胸壁肺动脉导管 心脏外科围术期监护 术后并发症 受试者工作特征曲线(ROC曲线) 

分 类 号：R61[医药卫生—外科学]