静动脉二氧化碳分压差在法洛四联症患者围术期心功能监测中的意义  

Significance of arteriovenous partial carbon dioxide pressure of difference in Fallot patients during the perioperative period

作　　者：祁明[1] 袁辉[1] 田青[1] 郑萍[1] 

机构地区：[1]武汉亚洲心脏病医院ICU,湖北武汉430022

出　　处：《心脏杂志》2013年第4期443-446,共4页Chinese Heart Journal

摘　　要：目的:探讨经过术后上腔静脉血氧饱和度(ScvO2)>60%的法洛(Fallot)四联症患者是否能够应用静动脉二氧化碳分压差(Pcv-aCO2)作为Fallot四联症围术期心排出量评估指标。方法:87例术后早期ScvO2>60%的Fallot四联症矫治患者,根据术后即刻Pcv-aCO2是否≥8 mmHg,分为高Pcv-aCO2组(34例)和低Pcv-aCO2组(53例)。观察2组患者在术后即刻,8、12、24和48 h时的血流动力学指标,灌注指标,心功能状态,恢复情况。结果:低PcvaCO2组心指数(CI)明显高于高Pcv-aCO2组(P<0.05),乳酸(Lac)、再插管率,无创呼吸机应用率,呼吸机辅助时间,住ICU时间及并发症均明显低于高Pcv-aCO2组(P<0.05);CI与全心舒张末容积(GEDV)正相关。结论:Fallot四联症患者术后早期Pcv-aCO2≥8 mmHg提示心排量不足,术后并发症的发生与早期高Pcv-aCO2水平有明显关系。AIM：To investigate whether arteriovenous carbon dioxide partial pressure of difference （PcvaCO2） can be used as a perioperative Fallot heart output index after postoperative superior vena cava oxygen saturation （ScvO2）〉60% in Fallot patients. METHODS： Eightyseven Fallot correction patients of early postoperative ScvO2〉60% were divided into high PcvaCO2 group and low PcvaCO2 group by PcvaCO2≥8 mmHg. Hemodynamic parameters, perfusion index, cardiac status and recovery were immediately observed in both groups 8, 12, 24 and 48 h after the surgery. RESULTS： Fiftythree cases were in the low PcvaCO2 group and 34 cases were in the high PcvaCO2 group. Confidence interval （CI） in low PcvaCO2 group was significantly higher than in the high PcvaCO2 group （P〈0.05）. Lactic acid, reintubation rate, application rate of noninvasive ventilation, mechanical ventilation time, time in ICU and complications in low PcvaCO2 group were significantly lower than those in high PcvaCO2 group （P〈0.05）. CI and global enddiastolic volume were positively correlated. CONCLUSION： Early PcvaCO2≥8 mmHg in Fallot patients may suggest lack of effective circulating blood flow. Early high level of PcvaCO2 is significantly associated with the occurrence of postoperative complications.

关 键 词：心脏外科手术 血流动力学 静脉二氧化碳分压 上腔静脉血氧饱和度 

分 类 号：R541.7[医药卫生—心血管疾病]