常温不停跳房间隔缺损修补术中乳酸变化的分析及对临床效果的影响  

The Change and its Significance of Level of Lactic Acid in Repair of Atrial Septal Defect in Beating Heart under Normal Temperature

作　　者：王锦鹤 金新会 傅建学 祁恒宁 马勇 

机构地区：[1]青海省心血管病专科医院,810012

出　　处：《青海医药杂志》2013年第1期7-9,共3页Qinghai Medical Journal

摘　　要：目的:观察常温心脏不停跳与浅低温心脏停跳手术两组患者的血乳酸值及临床效果,分析心脏不停跳体外循环技术对人体内环境的影响。方法:随机选择房间隔缺损患者50例,心功能(Ⅱ～Ⅲ)级。采用随机数字法分为两组,常温不停跳组(A组,n=25)和浅低温停跳组(B组,n=25)。采集两组患者麻醉诱导后5min(T1)、体外循环(CPB)中间时间点(T2)、CPB停机后10min(T3)、ICU 1h(T4)、ICU 6h(T5)、ICU 24h(T6)动脉血,检测乳酸(Lac)含量并进行分析。并记录两组患者体外循环(CPB)时间、手术时间、术后尿量、术后机械通气时间、ICU滞留时间、术后住院天数等情况。结果:①T1时点两组Lac值比较无统计学差异;②T2、T3、T4、T5时点,A组Lac值明显低于B组,差异有显著性(P<0.05);③T6时点两组Lac值比较无统计学意义。另外A组体外循环(CPB)时间、手术时间、术后尿量、术后机械通气时间较B组缩短,有统计学意义(P<0.05);ICU滞留时间、术后住院天数A组有缩短趋势,但无统计学意义。结论:常温不停跳体外循环技术在房间隔缺损修补术中对人体内环境影响小、且临床效果良好。objective： To observe the effects of changes of lactic acid （Lac） level on the human body environ- ment in repair of atrial septal defect （RASD） in beating heart under normal temperature. Methods ：50 patients with ASD of I ~III grade were assigned at the beating heart group （group A, n = 25 ） to receive RASD in beating heart under normal temperature, and arrest heart group （ group B, n = 25） to receive RASD by cardiopulmonary bypass （CPB） under mild hypothermic arrest. The arterial blood sample was collected at T1 （ after 5min, induced anesthe- sia）, T2 （during CPB）, T3 （after 10rain,stopped CPB）, I＇4, 35 and T6 （ICU lh,ICU 6h and ICU 24h）, and level of Ic was measured. More over, the operative time, CPB time, postoperative urine output, time of mechani- cal ventilation and ICU retention, so on were recorded. Results：（1）There was no a difference in Lac at T1 and T6 between the group A and group B （P 〉 0.05） ; ~）At T2, T3, 3＂4, 3＂5, the Lac level in group A was significantly lower than that in group B （ P 〈 0.05）. The CPB time, operative time, postoperative urine output and time of me- chanical ventilation in group A is shorter than in group B （ P 〈 0.05）. The time of ICU retention and postoperative hospitalization days trended to the shortage in group A, however, no difference compared with group B. Conclusions：RASD in beating heart under normal temperature would have small impact on the human body environment, and the clinical effect is good.

关 键 词：低温 常温 体外循环 心脏不停跳 血清乳酸 

分 类 号：R654.2[医药卫生—外科学]