体外循环下冠状动脉旁路移植术围手术期呼吸末二氧化碳与B型脑钠肽的变化及其意义  

Perioperative End Tidal Carbon Dioxide and B-type Brain Natriuretic Peptide Changes during Coronary Artery Bypass Grafting under Cardiopulmonary Bypass

作　　者：周凤高 杨德兴[2] 徐冕 刘桠名 许成 赵琨 蒋国云 刘荣[1] ZHOU Feng-gao;YANG De-xing;XU Mian;LIU Ya-ming;XU Cheng;ZHAO Kun;JIANGGuo-yun;LIU Rong(Emergency Intensive Care Unit,The 1st Affiliated Hospital of Kunming Medical University,KunmingYunnan 650032;Dept.of Emergency,The First People＇s Hospital of Yunnan,Kunming Yunnan 650034;Surgical Intensive Care Unit,Fuwai Cardiovascular Hospital of Yunnan Province,Kunming Yunnan650032,China)

机构地区：[1]昆明医科大学第一附属医院EICU,云南昆明650032 [2]云南省第一人民医院急诊科,云南昆明650034 [3]云南省阜外心血管病医院SICU,云南昆明650032

出　　处：《昆明医科大学学报》2018年第10期51-57,共7页Journal of Kunming Medical University

基　　金：云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目(2015FB022)

摘　　要：目的探讨体外循环(CPB)下冠状动脉旁路移植术(CABG)中患者呼吸末二氧化碳(ETCO_2)与血浆B型脑钠肽(BNP)的变化及其意义。方法选择2017年9月至2018年3月在云南省阜外心血管病医院在体外循环下冠状动脉旁路移植术的42例患者为研究对象。根据体外循环时间分为2组,A组:体外循环转流时间<120 min;B组:体外循环转流时间>120 min。并于术前(T_0)、体外循环前(T_1)、停循环时(T_2),停循环后1 h(T_3),停循环后4h(T_4)、停循环后12 h(T_5),停循环后24 h(T_6)、停循环后48 h(T_7)采用测定BNP浓度及以主流式方法监测ETCO_2值,观察其变化,并进行相关性分析。结果(1) 2组患者术前及术后的年龄、性别、氧合指数、APACHE Ⅱ评分及NYHA心功能分级的差异无统计学意义(P>0.05);(2)经完全随机设计资料的方差分析:2组BNP不同时间差异有统计学意义(P<0.05),进一步行LSD-t两两比较,T_4~T_7差异有统计学意义(P<0.05);经两独立样本t检验:2组患者的BNP在T_0至T_3时间点差异无统计学意义,在T_4以后的各个时间点差异均有统计学意义(P<0.05)。经完全随机设计资料的方差分析:2组ETCO_2不同时间点出现差异有统计学意义(P<0.05),进一步行LSD-t两两比较,A组T_3~T_7差异有统计学意义(P<0.05),B组T_2~T_7差异有统计学意义(P<0.05)。经两独立样本t检验:2组患者的ETCO_2除T_0、T_1、T_2时间点差异无统计学意义(P>0.05),其余各个时间点差异均有统计学意义(P<0.05)。根据Pearson相关性分析,ETCO_2在体外循环后T_4至T_7内与BNP具有相关性;A组各时间点(r在-0.623^-0.719之间,P<0.05);B组各时间点(r在-0.702^-0.787之间,P<0.05)。结论(1)体外循环下冠状动脉旁路移植术在体外循环后4~48 h内ETCO_2和BNP具有负相关性;(2)ETCO_2可作为体外循环下冠状动脉旁路移植术围手术期的一个重要的无创监测指标。Objective To investigate the changes and significance of end-tidal carbon dioxide（ETCO2） and plasma B-type brain natriuretic peptide（BNP） in patients undergoing coronary artery bypass grafting（CABG）under cardiopulmonary bypass（CPB）. Methods From September 2017 to March 2018,42 patients with coronary artery bypass grafting under cardiopulmonary bypass were selected at Fuwai Hospital of Cardiovascular Diseases in Yunnan Province as research objects. We divided the patients into two groups according to the time of cardiopulmonary bypass： group A： extracorporeal circulation transition time 120 min; group B： extracorporeal circulation transition time 120 min. Then we draw blood to determine the concentrations of BNP before the operation（T0）,before extracorporeal circulation（T1）,and stop-circulation（T2）,1 h after stoppage（T3）,4 h（T4）,12 h（T5）,and 24 h（T6）. 48 h（T7） and to monitor changes in ETCO2 values using a mainstream method. Correlation analysis was also performed. Results（1）There was no statistical significance regarding the age, gender,oxygenation index,APACHE Ⅱ score,and New York Heart Association class between the two groups before and after the operation.（2）After the variance analysis toward completely random designed data,there was a statistically significant difference in BNP between the two groups at different time points（P〈0.05）. further comparison between LSD-t,we found the significant differences from T4 to T7;Two independent samples t-tests showed no significant difference in BNP between the two groups from T0 to T3 and significant difference at each time point after T4（P〈0.05）. The variance analysis toward completely randomly designed data showed a statistically significant difference between the two groups at different time points（P〈0.05） and further comparison between LSD-t demonstrated the significant differences of T3-T7 in group A. The differences of T2-T7 were statistically significant. Two independent samples t-te

关 键 词：体外循环 冠状动脉旁路移植术 呼吸末二氧化碳 B型脑钠肽 

分 类 号：R541[医药卫生—心血管疾病]