上腔静脉重建术中血流动力学及脑氧代谢变化对手术策略的选择  

Intraoperative changes of hemodynamics and oxygen metabolism during SVC replacement for thoracic neoplasm

作　　者：何庚戌[1] 要彤[2] 李海英[1] 濮仁富[1] 蔡宝松[1] 张雁[1] 孙永杰[1] 

机构地区：[1]解放军第251医院胸心血管外科,河北张家口075000 [2]河北北方学院第一附属医院心电图室,河北张家口075000

出　　处：《实用肿瘤杂志》2015年第5期426-430,共5页Journal of Practical Oncology

摘　　要：目的探讨侵犯上腔静脉的胸部肿瘤手术中手术策略的选择对上腔静脉阻断期间脑氧代谢的影响。方法总结分析31例胸部肿瘤侵犯上腔静脉合并(阻断组,n=19)及未合并(旁路组,n=12)上腔静脉阻塞患者上腔静脉重建术中,直接阻断上腔静脉(阻断组)或旁路分流(旁路组)患者血流动力学改变、脑氧代谢及乳酸改变的情况。结果阻断组患者术前上腔静脉压力、脑氧摄取率、颈内静脉乳酸水平、颈静动脉乳酸差值明显高于旁路组,而颈内静脉血氧饱和度低于旁路组(均P<0.05)。血管重建后阻断组上腔静脉压力、脑氧摄取率、颈内静脉乳酸水平、颈静动脉乳酸差值明显下降,而颈内静脉血氧饱和度上升(均P<0.05);旁路组上腔静脉压力、脑氧摄取率、颈内静脉乳酸水平、颈静动脉乳酸差值以及颈内静脉血氧饱和度无明显改变(均P>0.05)。结论合并上腔静脉阻塞患者在上腔静脉重建过程中直接阻断上腔静脉进行肿瘤切除、腔静脉重建是安全的,未合并上腔静脉阻塞者进行上腔静脉至心房的旁路分流是必要的。Objective To investigate intraoperative changes of hemodynamics and oxygen metabolism during superior vena cava（ SVC） replacement for thoracic neoplasm and its relation to the choice of surgical modality. Methods Thirty-one patients underwent superior vena cava replacement,including 12 cases with superior vena cava totally obstructed（ SVCO group） and 19 cases with superior vena cava partially involved（ non-SVCO group）. During SVC replacement,SVC was directly clamped in SVCO group,and bypassed through temporary SVC to right atrial graft in non-SVCO group.Hemodynamic index,cerebral oxygen metabolism and lactate level were monitored during operation. Results SVC pressure,cerebral oxygen extraction,jugular venous lactate level and arterio-venous difference in lactate were significantly higher in SVCO group than those in non-SVCO group before operation,and decreased significantly after SVC reconstruction in SVCO group（ all P 〈0. 05）. Jugular venous oxygen saturation was lower in SVCO group before operation,and increased after SVC reconstruction（ P 〈0. 05）. No change was observed in these values after bypass procedure in non-SVCO group（ all P〉 0. 05）. Conclusion The direct clamp of SVC for SVCO patients is safe and effective. Bypass is essential for nonSVCO patients during SVC replacement for thoracic neoplasm.

关 键 词：胸部肿瘤/外科学 腔静脉 上 上腔静脉综合征 脑 氧 

分 类 号：R730.56[医药卫生—肿瘤]