先天性心脏病患儿术后早期胃黏膜pH值的变化及其与心功能的相关性研究  

Relationship between early gastric mucosal pH and cardiac function in infants with congenital heart disease undergoing cardiopulmonary bypass

作　　者：张彩云 张泽伟[2] 邱芸香[2] 范佳杰[2] 郑志杰[2] 

机构地区：[1]杭州市儿童医院内科,杭州310006 [2]浙江大学医学院附属儿童医院心胸外科,杭州310003

出　　处：《中华危重症医学杂志（电子版）》2016年第1期28-33,共6页Chinese Journal of Critical Care Medicine:Electronic Edition

摘　　要：目的探讨先天性心脏病患儿经体外循环心脏手术后早期胃黏膜pH值的变化及其与心功能的相关性。方法选择18例行体外循环心脏手术的先天性心脏病患儿。采用空气张力计法对胃黏膜二氧化碳分压(PCO_2)进行动态监测,计算标准胃黏膜pH值。同时,于患儿入外科重症监护病房0 h(T1)、4 h(T2)、8 h(T3)、12 h(T4)、24 h(T5)、48 h(T6)及72 h(T7)七个时间点记录并比较胃黏膜pH值、心指数、混合静脉血氧饱和度(SvO_2)及血乳酸水平。并采用Pearson相关分析胃黏膜pH值、SvO2、血乳酸水平与心指数之间的相关性。结果所有患儿不同时间点胃黏膜p H值、心指数、SvO_2、血乳酸指标的变化均有统计学意义(F=5.702、8.225、3.164、13.051,P均<0.05)。进一步两两比较发现,胃黏膜pH值T2为7.33±0.07,显著低于T6、T7(7.39±0.06、7.40±0.06,P均<0.05);心指数值T6、T7分别为(4.32±0.75)L·min-1·m^(-2)、(4.24±0.78)L·min^(-1)·m^(-2),均显著高于T1、T2、T3、T4[(3.61±1.09)L·min-1·m-2、(3.60±1.06)L·min-1·m-2、(3.42±0.87)L·min^(-1)·m^(-2)、(3.33±0.94)L·min^(-1)·m^(-2),P均<0.05],SvO_2水平T3、T4分别为(71.7±8.2)%、(72.3±7.8)%,均显著低于T5、T6、T7[(79.9±6.5)%、(78.5±5.7)%、(78.1±5.1)%,P均<0.05],而血乳酸水平T1、T2分别为(1.77±0.79)mmol/L、(1.72±0.83)mmol/L,均显著高于T3、T4、T5、T6、T7[(1.52±0.89)mmol/L、(1.31±0.45)mmol/L、(0.99±0.35)mmol/L、(0.77±0.23)mmol/L、(0.73±0.18)mmol/L,P均<0.05]。Pearson相关分析发现,心指数与胃黏膜pH值、SvO_2呈正相关(r=0.247、0.419,P均<0.05),与血乳酸呈负相关(r=-0.318,P<0.05)。结论胃肠黏膜pH值、SvO_2与动脉血乳酸值与心指数相关,可以反映心功能的变化。Objective To explore the relationship between early gastric mucosal p H and cardiac function in infants with congenital heart disease undergoing cardiopulmonary bypass.Methods A total of 18 infants with congenital heart disease undergoing cardiopulmonary bypass were enrolled in this study. The air tension meter method was used to dynamically detect the arterial partial pressure of CO2 of gastric mucosal, and gastric mucosal p H was calculated. The gastric mucosal p H, cardiac index, oxygen saturation of mixed venose blood（SvO2） and blood lactic acid at 0 h（T1）, 4 h（T2）, 8 h（T3）, 12 h（T4）, 24 h（T5）, 48 h（T6） and 72 h（T7） after surgical intensive care unit were recorded and compared. The Pearson correlation analysis was used to analyze the relationship between early gastric mucosal pH, SvO2, blood lactic acid and cardiac index. Results The gastric mucosal p H, cardiac index, SvO2 and blood lactic acid at different times all showed significant differences（F = 5.702, 8.225, 3.164, 13.051, all P〈0.05）. The gastric mucosal pH at T2 was 7.33 ± 0.07, lower than those at T6 and T7（7.39 ± 0.06, 7.40 ±0.06, all P〈0.05）. The cardiac index at T6 and T7were（4.32 ± 0.75） L·min^-1·m^-2（4.24 ±0.78） L·min^-1·m^-2respectively, higher than those at T1, T2, T3 and T4[（3.61 ± 1.09） L·min^-1·m^-2（3.60 ± 1.06） L·min^-1·m^-2（3.42 ± 0.87） L·min^-1·m^-2（3.33 ± 0.94） L·min^-1·m^-2 all P〈0.05]. The level of SvO2 at T3and T4were（71.7 ± 8.2）%,（72.3 ± 7.8）% respectively, lower than those at T5,T6 and T7[（79.9 ± 6.5）%,（78.5 ± 5.7）%,（78.1 ± 5.1）%, all P〈0.05]. And the levels of blood lactic acid at T1 and T2were（1.77 ± 0.79） mmol / L,（1.72 ± 0.83） mmol / L, respectively, higher than those at T3, T4, T5, T6 and T7[（1.52 ± 0.89） mmol / L,（1.31 ± 0.45） mmol / L,（0.99 ± 0.35） mmol / L,（0.77 ± 0.23） mmol / L,（0.73 ± 0.18） mmol / L, all P〈0.05]. Meanwhile, the Pearson correlation analysis showed that

关 键 词：体外循环 心脏缺损 先天性 胃黏膜PH值 婴幼儿 

分 类 号：R726.5[医药卫生—儿科]