Pv-aCO2联合被动抬腿试验指导非体外循环冠状动脉旁路移植术后患者的容量管理  

Mixed venous-arterial carbon dioxide difference combined with passive leg raising in guiding volume management for patients post off-pump coronary artery bypass grafting

作　　者：霍丽坤 李培军[2] 解畅[2] 闫成雷[2] 李杰[2] 

机构地区：[1]天津医科大学研究生院,300070 [2]天津市胸科医院重症医学科,300222

出　　处：《中华危重病急救医学》2017年第4期353-357,共5页Chinese Critical Care Medicine

基　　金：天津市科技计划项目（2013KZ074）

摘　　要：目的 探讨混合静脉-动脉血二氧化碳分压差（Pv-aCO2）联合被动抬腿试验（PLR）对非体外循环冠状动脉旁路移植术（OPCABG）术后患者容量管理的指导作用.方法 选择2016年6月1日至10月1日天津市胸科医院择期行OPCABG术后患者80例,按随机数字表法分为观察组（以Pv-aCO2联合PLR指导容量管理）和对照组〔以中心静脉压（CVP）指导容量管理〕,每组40例.比较两组患者入院时和术后6 h体温（T）、心率（HR）、平均动脉压（MAP）、CVP、氧合指数（PaO2/FiO2）、混合静脉血氧饱和度（SvO2）、Pv-aCO2、血乳酸（Lac）,6 h液体净入量、血管活性药物评分,24 h序贯器官衰竭评分（SOFA）,机械通气时间、ICU住院时间、总住院时间.采用Spearman相关分析法分析观察组Pv-aCO2与心排血指数（CI）和Lac的相关性.结果 两组术后6 h T、HR、MAP、CVP、PaO2/FiO2、SvO2、Lac均较入院时升高,Pv-aCO2明显下降,且观察组SvO2、液体净入量明显高于对照组〔SvO2：0.671±0.068比0.634±0.052,液体净入量（mL）：454±151比304±106,均P〈0.05〕,Pv-aCO2、Lac、血管活性药物评分明显低于对照组〔Pv-aCO2（mmHg,1 mmHg=0.133 kPa）：6.1±1.8比7.0±1.8,Lac（mmol/L）：1.7±0.5比2.8±0.6,血管活性药物评分（分）：3.18±1.01比4.48±1.50,均P〈0.05〕,机械通气时间、ICU住院时间均较对照组明显缩短（h：16.52±6.41比21.96±9.00,45.51±9.36比51.76±13.66,均P〈0.05）;观察组与对照组24 h SOFA评分（分：4.50±1.85比5.02±2.08）、总住院时间（d：12.1±4.3比13.0±5.5）比较差异无统计学意义（均P〉0.05）.观察组Pv-aCO2与CI呈负相关（r=-0.752,P〈0.001）,与Lac无相关性（r=-0.154,P=0.171）.结论 Pv-aCO2联合PLR可以更好地指导OPCABG术后患者的容量管理,减少血管活性药物用量,缩短机械通气时间和ICU住院时间.Objective To investigate whether mixed venous-arterial carbon dioxide difference （Pv-aCO2） combined with passive leg raising （PLR） could better guide volume management for patients post off-pump coronary artery bypass grafting （OPCABG）.Methods Eighty patients experienced OPCABG, and admitted to Tianjin Chest Hospital from June 1st to October 1st in 2016 were enrolled. They were randomly divided into two groups： observation group given Pv-aCO2 combined with PLR directed therapy and control group given central venous pressure （CVP） directed therapy, 40 cases in each group. The difference in body temperature （T）, heart rate （HR）, mean arterial pressure （MAP）, CVP, oxygenation index （PaO2/FiO2）, mixed venous oxygen saturation （SvO2）, Pv-aCO2, blood lactate （Lac）, fluid intake, scores of the vasoactive agents at 6 hours post-operation, sequential organ failure assessment （SOFA） of 24 hours, mechanical ventilation time, the length of intensive care unit （ICU） stay, and hospitalization time were compared. The correlation between Pv-aCO2 and cardiac index （CI）, Pv-aCO2 and Lac were analyzed by Spearman analysis in observation group.Results The T, HR, MAP, CVP, PaO2/FiO2, SvO2 and Lac at 6 hours post-operation were higher than those at admission in two groups, and Pv-aCO2 were significantly decreased. The SvO2 and fluid intake in observation group were higher than those in control group [SvO2： 0.671±0.068 vs. 0.634±0.052, fluid intake （mL）： 454±151 vs. 304±106, bothP 〈 0.05], Pv-aCO2, Lac and scores of the vasoactive agents were lower than those in control group [Pv-aCO2 （mmHg, 1 mmHg = 0.133 kPa）： 6.1±1.8 vs. 7.0±1.8, Lac （mmol/L）： 1.7±0.5 vs. 2.8±0.6, scores of the vasoactive agents： 3.18±1.01 vs. 4.48±1.50, allP 〈 0.05], mechanical ventilation time and the length of ICU stay were less than those in the control group （hours： 16.52±6.41 vs. 21.96±9.00, 45.51±9.36 vs. 51.76±13.66, bothP〈 0.05）. There was no significant di

关 键 词：混合静脉-动脉血二氧化碳分压差 被动抬腿试验 非体外循环 冠状动脉旁路移植术 容量管理 

分 类 号：R654.2[医药卫生—外科学]