人体动脉血气信号波浪式变化及连续动脉逐搏取血血气分析方法的建立  

Evidence of waveform information in arterial blood gas by beat-by-beat sampling method in patients with normal heart function

作　　者：孙兴国[1] 姚优修[1,2] 李军[1] 王古岩[1] 张宏亮[1] 谭晓越[1] 刘方[1,3] 慈政 胡盛寿[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心血管疾病国家重点实验室心血管疾病国家临床医学研究中心,北京100037 [2]北京大学第三医院麻醉科,北京100083 [3]潍坊医学院临床医学系,山东潍坊261000

出　　处：《中国应用生理学杂志》2015年第4期316-321,共6页Chinese Journal of Applied Physiology

基　　金：国家自然科学基金医学科学部面上项目(81470204);国家高新技术研究发展计划(863计划)课题(2012AA021009);中国医学科学院国家心血管病中心科研开发启动基金(2012-YJR02)

摘　　要：目的:建立动脉逐搏取血血气分析法,在人体实验中验证呼吸调控核心信号——PaO2,Pa CO2和[H+]a是受呼吸影响的周期性、波浪式变化信号,而不是传统理念上误认的稳定水平信号。方法:选择心功能正常、Allen试验阴性需要监测动脉血流动力学变化的患者6例。在左侧桡动脉穿刺,连接肝素化塑化管(3mm×1 000 mm),注满血液并计数血液注满所需心跳次数。用止血钳将塑化管钳闭成与心跳次数相对应的分段后,迅速置于冰水中,立即进行血气分析。选取每位患者的2个典型波浪式周期,用于分析2对最高-最低和最低-最高共4个测定值,取平均值。对相邻最高和最低值作统计学配对t检验。结果:血液注满塑化管需要16±2次心跳,均覆盖超过2个呼吸周期。每个呼吸周期是5±0.6次心跳。PaO2、PaCO2、[H+]a和SaO2都呈现出明显的波浪式变化(相邻高点与低点比较,P<0.05),PaO2、Pa CO2、[H+]a和SaO2的波浪幅度分别是(11.28±1.13)mm Hg,(1.77±0.89)mm Hg,(1.14±0.35)nmol/L和(0.52±0.44)%;波浪幅度分别是其平均值的(7.7±1.1)%,(5.1±2.5)%,(3.1±1.0)%和(0.5±0.4)%。结论:动脉延长管连续取血,按心跳次数分隔血样,血气分析法简单易行,为验证动脉血气受呼吸影响的周期性波浪式信号提供了可靠证据。本方法为原创,技术操作层面仍需提高熟练程度,增加志愿者和试验样本的数量进一步探索此类信号的临床检测可靠性及其与临床疾病的关系。Objective： Since 2011 EB-APS conference, we hypotheses that phase switching of inspiration-expiration is dominantly initiated by oscillatory information PaO2, PaCO2 and [H＋] via fast peripheral chemical receptors. However, the evidence of the waveform of ABG is lack. Methods： Six surgery patients with normal heart function and negative Allen test, had been placed the arterial catheterization directly connected to 3 x 1 000 mm pre-heparin plastic pipe for continuous collecting arterial blood. We counted the number of heart beat for the blood collecting time, and separated the blood pipe into the heart beat numbers＇ short pieces using haemostatic forceps, then put pipe into iced water at once fir analyzing PaO2, PaCO2, pH and SaO2 as soon as possible. We selected two breaths cycles of waveform from each patient for data calculations of magnitudes and time interval. Results： The heart beat numbers for filling blood into pipe were 16±2, and all covered more than 2 breathing cycles. Each breathing cycle is cover 5±0.6 heart beat. There were significant changes of PaO2, PaCO2, [H＋]a and SaO2 （ i.e. the highest high values compare to the next lowest values, P〈0.05）. The time interval of changing PaO2, PaCO2 [H＋]a and SaO2 magnitudes were 11.28±1.13 mmHg, 1.77±0.89 mmHg, 1.14＋0.35nmol/L and 0.52%＋0.44% respectively. Conclusion： This simple continuous beat-bybeat arterial blood sampling and ABG analyzing method is new and practicable. We obtain a clear evidence of periodic parameters ABG waveform, which following breathing cycle.

关 键 词：动脉血气分析 动脉氧分压 动脉pH 动脉氧饱和度 动脉逐搏取血 波浪式呼吸 呼吸调控 

分 类 号：R333[医药卫生—人体生理学]