二氧化碳在瓣膜手术中的应用及护理管理  

The application and nursing management of carbon dioxide in the valve patients with cardiopulmonary bypass

作　　者：张鸿英[1,2] 李砚萍[1,3] 

机构地区：[1]首都医科大学附属北京安贞医院 [2]北京市心肺血管疾病研究所手术室,100029 [3]北京市心肺血管疾病研究所体外循环科,100029

出　　处：《心肺血管病杂志》2015年第8期646-647,共2页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:评价心脏瓣膜手术术中向术野吹入二氧化碳对心脏复跳的影响。方法:连续选取2011年10月至2013年3月间,在北京安贞医院行心脏瓣膜病手术患者140例,根据术中是否向术野吹入二氧化碳,分为试验组(二氧化碳组,n=70)和对照组(未使用二氧化碳组,n=70),观察开放升主动脉后心脏复跳情况。结果:所有患者手术均成功,无一例住院死亡。两组患者的一般临床资料、体外循环转机时间、主动脉阻断时间等相关参数差异均无统计学意义(P>0.05)。开放升主动脉后试验组患者中52例心脏自动复跳,自动复跳率为74.3%,明显高于对照组患者(26例,37.1%),差异具有明显统计学意义(P<0.01)。开放升主动脉后,经食道超声观察发现试验组患者心腔内残余的气体较少。结论:心脏瓣膜手术术中向术野吹入一定量的二氧化碳,可提高心脏自动复跳率,具有一定的心肌保护作用,值得临床推广应用。Objective： To observe the clinical effect of myocardial protection using carbon dioxide in the valve patients with cardiopulmonary bypass. Methods：From October 2011 to March 2013, 140 patients with cardiac valve disease scheduled for cardiac surgery with cardiopulmonary bypass were enrolled and randomized into experimental （carbon dioxide） group and control （no carbon dioxide） group, 70 cases each. The ratio of cardiac resuscitation were compared between two groups. Results：All patients cardiac procedure were success- ful, and survival to discharge. There were no significant differences in preoperative clinical characteristics, du- ration of cardiopulmonary bypass and aortic cross clamping （ P 〉 0.05 ） . The ratio of cardiac resuscitation were significantly higher in the experimental group than those in the control group （74.3% vs 37.1%, P 〈0.01 ）. There were found less residual gas in the cardiac chambers after aortic de-clamping. Conclusion：Carbon dioxide can improve cardiac resuscitation rate, provide myocardial protective effect in patients undergoing the valve operation with cardiopulmonary bypass. This technique is worthy of clinical expansion.

关 键 词：二氧化碳 瓣膜置换 护理管理 

分 类 号：R54[医药卫生—心血管疾病]