P(v-a)CO2/C(a-v)O2在体外循环心脏术后容量管理中的价值  

Value of P (v-a)CO_2/C (a-v)O_2 in capacity management after cardiopulmonary bypass cardiac surgery

作　　者：诸葛建成 方红龙[1] 罗建[1] 陈梅琴 吴华勇[1] 张伟文[1] ZHUGE Jiancheng;FANG Hcnglong;LUO Jian(Intensive Care Unit of Quzhou Municipal TCM Hospital,Quzhou 324000,China)

机构地区：[1]衢州市人民医院重症医学科,324000 [2]衢州市中医医院

出　　处：《浙江医学》2018年第11期1221-1225,共5页Zhejiang Medical Journal

摘　　要：目的探讨动静脉二氧化碳分压差/动静脉氧含量差[P(v-a)CO_2/C(a-v)O_2]在体外循环心脏术后容量管理中的价值。方法收集2014年1月至2015年12月行心脏手术患者126例,以容量负荷试验后氧输送(DO_2)增加≥10%的患者共94例作为研究对象,根据氧消耗(VO_2)增加是否≥10%分成VO_2有反应组56例(△VO_2≥10%)和VO_2无反应组38例(△VO_2<10%),比较血流动力学参数、乳酸、中心静脉氧饱和度(ScvO_2)、中心静脉-动脉二氧化碳分压差[P(v-a)CO_2]、P(v-a)CO_2/C(a-v)O2等指标。结果 VO_2有反应组与VO_2无反应组患者容量负荷试验前后乳酸、ScvO_2比较均无统计学差异(P>0.05);容量负荷试验前,VO_2有反应组P(v-a)CO_2、P(v-a)CO_2/C(a-v)O_2均较VO_2无反应组升高(P<0.05);VO_2有反应组容量负荷试验后P(v-a)CO_2、P(v-a)CO_2/C(a-v)O2较容量负荷试验前下降(P<0.05);VO_2无反应组容量负荷试验前后P(v-a)CO_2、P(v-a)CO_2/C(a-v)O_2比较无统计学差异(P>0.05);ROC曲线分析得出乳酸、ScvO_2对判断VO_2/DO_2依赖无价值(P>0.05);P(v-a)CO_2≥6.42mm Hg判断VO_2/DO_2依赖的AUC为0.750,其灵敏度为78.43%,特异度为72.60%(P<0.05);P(v-a)CO_2/C(a-v)O2≥1.45mm Hg/ml判断VO_2/DO_2依赖的AUC为0.965,其灵敏度为86.70%,特异度为100%(P<0.05)。结论 P(v-a)CO_2/C(a-v)O2是反映VO_2/DO_2依赖的良好指标,能有效判断组织缺氧,指导体外循环心脏术后容量负荷试验阳性患者的液体治疗。Objective To assess the value of P（v-a）CO2/C（a-v）O2 in capacity management after cardiopulmonary bypass cardiac surgery. Methods A total of 126 patients underwent cardiac surgery in Quzhou Hospital from January 2014 to December 2015, among whom the capacity load after oxygen delivery （DO2） increased by ≥10% in 94 cases. In these 94 cases,there were 56 cases with oxygen consumption increase（△VO2）≥10% （VO2 response group） and 38 cases with△VO2〈10% （VO2 non-response group） . Hemodynamic parameters, lactic acid, central venous oxygen saturation（ScvO2）, central venous-arterial carbon dioxide partial pressure difference [P （V-A） CO2], P （V-A） CO2/C （A-V） O2 and other indicators were compared between two groups. Results There were no significant differences in lactic acid and ScvO2 before and after the capacity load test between VO2 response group and the VO2 non-response group（P 〉0.05）. Before the capacity load test, P（V-A） CO2, P（V-A） CO2/C（A-V） O2 in VO2 response group were higher than those in VO2 non-response group（P〈0.05）; while the P（V-A）CO2, P （V-A） CO2/C （A-V） O2 were decreased after the capacity load test in the VO22 response group （P〈0.05）. There were no significant differences in P（v-a）CO2, P（v-a）CO2/C（a-v）O2 before and after capacity load test in the VO2 non-response group（P 〉0.05）. ROC curve showed that lactic acid and ScvO2 had no value for VO2/DO2 （P 〉0.05）; the area under the curve of P（v-a）CO2 was 0.750, taking ≥6.42mmHg as cut-off value for VO2/DO2, the sensitivity was 78.43%, specificity was 72.60% （P〈0.05） ; the area under the curve of P（v-a）CO2/C（a-v）O2 was 0.965, taking ≥1.45mmHg/ml as cut-off value for VO2/DO2, the sensitivity was 86.70% and the specificity was 100%（P〈0.05）. Conclusion P（v-a）CO2/C（a-v）O2 is a good indicator of VO2/DO2, which can effectively determine the tissue hypoxia and can be used to guide the positive of capacity load test a

关 键 词：动静脉二氧化碳分压差/动静脉氧含量差 体外循环 心脏术后 容量管理 

分 类 号：R654.2[医药卫生—外科学]