基于“寸口”脉搏波测控的体外循环搏动灌注模式探索  

Research on cardiopulmonary bypass perfusion mode based on "Cunkou" pulse wave

作　　者：郭喆千[1] 张志枫[1] 许家佗[1] 屠立平[1] 李欣[2] 郭震 史美育[1] 千英信[1] 包怡敏[1] 

机构地区：[1]上海中医药大学基础医学院,上海201203 [2]上海交通大学附属胸科医院体外循环室,上海200030

出　　处：《上海中医药杂志》2013年第4期15-18,共4页Shanghai Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81173200);上海市卫生局中医药科研基金项目(2010J015A);科技部"十二五"国家科技支撑计划项目(2012BAI37B06)

摘　　要：目的通过"寸口"脉搏波测控观察体外循环不同灌注模式对机体功能的影响,探索建立基于"寸口"脉搏波测控的体外循环有效搏动灌注模式。方法将40例行体外循环术的心脏病患者随机分为搏动灌注组20例和非搏动灌注组20例,体外循环方法分别采用搏动灌注法和非搏动灌注法;观察两组患者术中"寸口"脉搏波波形;手术前后检测血液乳酸脱氢酶、门冬氨酸氨基转移酶、肌酐、尿素氮、尿酸,术中血乳酸、尿量,以及体外循环前(T1)、体外循环结束后2 h(T2)、体外循环结束后24 h(T3)血液肿瘤坏死因子、白细胞介素-6、白细胞介素-8等指标。结果 20例搏动灌注患者"寸口"均检测到脉搏波(单峰波、双峰波、三峰波),20例非搏动灌注患者"寸口"未能检测到脉搏波;两组患者手术前后乳酸脱氢酶、门冬氨酸氨基转移酶、肌酐、尿素氮、尿酸差值差异无统计学意义(P>0.05);搏动灌注组术中乳酸水平明显低于非搏动灌注组(P<0.05),单位时间尿量明显多于非搏动灌注组(P<0.01);两组患者T1、T2、T3三个时间节点的肿瘤坏死因子、白细胞介素-6、白细胞介素-8水平差异无统计学意义(P>0.05)。结论搏动灌注对改善体外循环患者肾血流灌注及机体缺氧状况有一定的优势;患者"寸口"可检测到单峰、双峰、三峰脉搏波,提示搏动血流能量能有效传递到外周血管,通过一定的优化设计;建立基于"寸口"脉搏波测控的体外循环有效搏动灌注模式具有可行性。Objective To observe the effect of cardiopulmonary bypass perfusion modes on bodily function by monitoring ＂ Cunkou＂ pulse, and to explore the effective perfusion mode. Methods Forty cases were randomized into pulsatile perfusion group and nonpulsatile perfusion group, 20 cases in each group. The ＂Cunkou＂ pulse wave, lactate dehydrogenase, aspartate aminotransferase, creatinine, urea nitrogen, uric acid, blood lactate, urine output, tumor necrosis factor, interleukin-6, interleukin-8 were observed. Results The pulse waves were detected in 20 cases of pulsatile perfusion group, and no pulse wave was found in nonpulsatilc perfusion group; there is no significant difference in lactate dehydrogenase, aspartate aminotransferase, creatinine , urea nitrogen, uric acid between the two groups （ P 〉 0.05 ） ; the lactate level in pulsatile perfusion group was significantly lower than that of the nonpulsalile perfusion group （ P 〈 0.05 ） ; the urine output during CPB was significantly higher in pulsatile perfusion group （P 〈0.05 ） ; there is no significant difference in tumor necrosis factor, interleukin-6 and interleukin-8 between the two groups （ P 〉 0.05 ）. Conclusion Pulsatile perfusion has certain advantages in improving cardiopulmonary bypass in patients with renal perfusion and hypoxia condition, the pulse waves can be detected in ＂ Cunkou＂ ; it shows that pulsatile perfusion blood flow energy can pass to outward through optimized design. It is feasible to establish effective pulsatile perfusion modes based on ＂Cunkou＂ pulse wave measurement.

关 键 词：体外循环 搏动灌注 “寸口”脉搏波 

分 类 号：R241.1[医药卫生—中医诊断学] R23[医药卫生—中医临床基础]