混合静脉血氧饱和度联合混合静脉-动脉二氧化碳分压差在评估心肺转流心脏术后患者预后中的价值  

Value of SO_2 combined with Pv-aCO_2 in the evaluation of cardiac surgery patients in prognosis

作　　者：张海瑛[1,2] 潘传亮[1,2] 刘剑萍[1,2] 

机构地区：[1]重庆医科大学附属成都第二临床医学院 [2]成都市第三人民医院重症医学科,成都市610031

出　　处：《临床麻醉学杂志》2015年第7期678-681,共4页Journal of Clinical Anesthesiology

基　　金：四川省卫生厅自然科学研究项目(110033)

摘　　要：目的探讨混合静脉血氧饱和度(SvO2)联合混合静脉-动脉二氧化碳分压差(Pv-aCO2)在评估心肺转流心脏术后患者预后中的价值。方法选择2011年12月至2014年3月在我院择期行心肺转流心脏手术并行肺动脉漂浮导管检查术、桡动脉置管术的患者281例。按转入ICU时(T1)SvO2及Pv-aCO2水平将患者分为三组:A组(SvO2≥65%且Pv-aCO2<6mm Hg)、B组(SvO2≥65%且Pv-aCO2≥6mm Hg)及C组(SvO2<65%)。患者转入ICU后,未达标的B、C组,以SvO2≥65%且Pv-aCO2<6mm Hg为早期目标导向治疗(EGDT)靶点,立即予EGDT治疗,已达标的A组予以维持的EGDT治疗,观察三组术后24h(T2)、48h(T3)、72h(T4)时病情变化及预后。结果按T1时SvO2及Pv-aCO2水平,结果 A组73例,B组91例,C组117例。A组术后机械通气时间明显短于B、C组;A组术后ICU住院时间明显短于C组(P<0.05)。A组急性胃肠功能损伤(AGI)、急性肾损伤(AKI)、恶性心律失常、急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)、出血、感染等并发症的发生率和术后7、28d死亡率明显低于C组(P<0.05)。结论满足SvO2≥65%且Pv-aCO2<6mm Hg的患者机械通气时间及ICU住院时间短,并发症发生率低,术后7、28d死亡率低,术后病情及预后更好。Objective To investigate the value of combined venous oxygen saturation（SvO2）and mixed venous arterial carbon dioxide partial pressure difference（Pv-aCO2）in the prognosis of patients with cardiopulmonary bypass after cardiac surgery.Methods From 2011 December to 2014 March in our hospital underwent cardiopulmonary bypass heart operation parallel Swan-Ganz catheterization,radial artery catheterization 281 cases of patients for cardiac surgery.patients.Transferred to ICU（T1）SvO2and Pv-aCO2 levels in the patients were divided intothree groups：group A（SvO2≥65% and Pv-aCO26mm Hg）,group B（SvO2≥65%and Pv-aCO2≥6mm Hg）and group C（SvO265%）.Patients transferred to the ICU,did not meet the groups B,C,SvO2≥65% and Pv-aCO26 mm Hg targeting early goal-directed therapy（EGDT）,immediately to EGDT treatment,EGDT treatment group A has standards be maintained,three groups were observed after 24,48,72h（T2,T3,T4）changes and prognosis of time difference point condition.Results According to SvO2,the levels of and Pv-aCO2 were T1,the results of 73 cases in group A,91 cases in group B and 117 cases in group C.The mechanical ventilation time of group A was shorter than that of groups B and C,and the length of ICU in group A was shorter than that of group C（P〈0.05）.The incidence of complications such as acute gastrointestinal damage（AGI）,acute renal injury（AKI）,malignant arrhythmia,acute lung injury and acute respiratory distress syndrome（ALI/ARDS）,bleeding,infection and so on in group A were significantly lower than that of group C（28d）,and the mortality of 7-day,28-day was significantly lower than that of the group C（P〈0.05）.Conclusion Satisfy patients with mechanical ventilation time and ICU SvO2≥65%and Pv-aCO26mm Hg short time of hospitalization,complication rate is low,7d,28 dmortality rate is low,the severity and prognosis of postoperative.

关 键 词：混合静脉血氧饱和度 混合静脉-动脉二氧化碳分压差 心肺转流心脏术后 

分 类 号：R654.2[医药卫生—外科学]