低体温对冠心病搭桥手术患者术后并发症发生概率的影响  

Effects of coronary bypass operation in patients with low temperature on the incidence of postoperative complications

作　　者：杨森[1] 宋波[2] 邱璇[2] 戴晋[1] 张雷[2] 李俊峰[3] 王秋波[4] 樊修元 王雪[1] 

机构地区：[1]锦州市中心医院麻醉科,辽宁省锦州市121000 [2]锦州市中心医院洁净手术部,辽宁省锦州市121000 [3]锦州市中心医院心血管外科,辽宁省锦州市121000 [4]锦州市中心医院检验科,辽宁省锦州市121000

出　　处：《中国心血管病研究》2016年第2期178-181,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的探讨冠心病搭桥手术患者低体温与术后并发症发生的关联。方法选取锦州市中心医院2012年1月至2015年1月冠心病搭桥手术患者645例，年龄（56．1±9．3）岁。所有手术均采用低温体外循环，手术时间为（3．56±1．68）h。分别记录体外循环结束时温度（T1）、出室时温度（T2）、术后1h温度（T3）、术后2h温度（T4）、术后5h温度（L），计算T=（T1＋T2＋T3＋T4＋T5）／5。根据T值划分为低体温组（M1，T〈35．5℃）、亚低温组（M2，35．5℃≤T〈36．2℃）、正常体温组（M3，36．2℃≤T≤37．3℃）和高体温组（M4，T〉37．3℃）。所记录温度为直肠温度。结果M1凝血酶原时间为（34．7±6．2）s，术后5h引流量（467±174）ml，与M3的（10．1±5．8）s和（258±132）ml相比较差异有统计学意义；M1在ICU滞留的时间与M3组相比较未见统计学差异，但机械通气时间延长8．7h；主要不良心血管事件的发生率M1高于其他各组。结论冠心病搭桥术围手术期的低体温发生率为50％-70％，会对机体凝血机制、氧耗量、脏器功能等产生一系列影响。低温可激发寒颤反射，寒颤会使机体的耗氧量增加4-5倍，同时还往往伴随血清儿茶酚胺的增高，这种高代谢状态加重了受损心脏的负担，增加了心肌缺血的发生率。低温时脏器血流量减少，对肝、肾、脑等脏器功能产生影响。Objective To investigate the relationship between low temperature and postoperative complications in patients undergone with CABG. Methods 645 cases undergone cardiopulmonary bypass in our hospital from 2012 to 2015 were enrolled, the end of CPB temperature （T1） and room temperature （T2） were recorded, temperature after 1 hour （T3）, postoperative 2 hours temperature （T4）, temperature after 5 hours（T5） were collected and T=（T1±T2T3±T4±T5）/5 was calculated. The patients were divided into hypothermia group（ M1 ）：T〈 35.5℃, mild hypothermia group （M2）：35.5 ℃≤T〈36.2 ℃, normal temperature group （M3）：36.2℃≤T≤37.3℃, high temperature group （M4）：37.3 ℃ 〈T according to the T values. The recorded temperature was of rectal temperature. Results M3 compared to M1, the prothrombin time and 5 h drainage postoperation were （34.7±6.2）s and （467±174）ml in M1, in M3 were （10.1±5.8）s and （258±132）ml, and there were significantly difference between two groups. The ICU retention time between two groups showed no significant difference. The awake and extubation time were extend 8.7 h in Ml, and major adverse cardiovascular event rates in Ml was higher than the other groups. Conclusion Low temperature rate in all patients undergone CABG is 50%-70%, and produces a series of adverse effeets to the eoagulation, oxygen consumption and organ function.

关 键 词：冠脉搭桥术 体外循环 围术期 低体温 并发症 

分 类 号：R654.2[医药卫生—外科学]