二氧化碳流量设定在左心直视手术中排气效果的研究  

The exhaust effect of carbon dioxide flow setting in left heart surgery

作　　者：王云[1] 韩小红[1] 周莎莎[1] WANG Yun;HAN Xiao-hong;ZHOU Sha-sha(Department of Thoracic and Cardiovascular Anesthesia,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院心血管麻醉手术科,江苏省南京市210006

出　　处：《中国心血管病研究》2020年第4期341-344,共4页Chinese Journal of Cardiovascular Research

基　　金：江苏省科技发展计划项目(BE2017609);南京市医学科技发展项目(课题)计划(YKK17100)。

摘　　要：目的拟通过设定不同流量的二氧化碳(carbon dioxide,CO2)在左心直视手术时进行排气,探讨低流量与高流量的CO2是否具有同样的排气效果,且具有脑保护作用.方法选取2018年10月至2019年10月我院体外循环(CPB)下左心直视瓣膜手术患者90例,根据患者住院数字号将患者随机分成三组,试验组从CPB建立至主动脉开放期间进行CO2充溢,根据流量不同分为两组:试验Ⅰ组采取常规排气方法+2 L/min流量,试验Ⅱ组采取常规排气方法+5 L/min流量,对照组采取常规排气方法.比较三组主动脉开放后微气泡数量、CPB辅助心功能时间、术后血清S100β血清水平、术中PCO2及术后伤口愈合不良发生率.结果试验Ⅰ组、试验Ⅱ组术中微气泡数量(Ⅰ组:5.9±0.6,Ⅱ组:6.3±0.4,对照组:9.8±0.7)、CPB辅助心功能时间[Ⅰ组(16.7±2.2)min,Ⅱ组(17.0±2.9)min,对照组(21.5±3.1)min]均少于对照组(P<0.05);试验Ⅱ组患者血清S100β血清水平[主动脉开放后2 h:Ⅰ组(1.17±0.48)μg/L;Ⅱ组(2.61±0.33)μg/L;对照组(1.94±0.31)μg/L;术后24 h:Ⅰ组(0.39±0.11)μg/L;Ⅱ组(1.73±0.29)μg/L;对照组(1.01±0.21)μg/L,P<0.05]及PaCO2需调整率明显高于其他两组患者(Ⅱ组比Ⅰ组比对照组:16/30比2/30比8/30,P<0.05);试验Ⅱ组患者术后愈合不良的发生率存在高于其他两组的趋势(Ⅱ组比Ⅰ组比对照组:9/30比3/30比3/30),但差异无统计学意义(P>0.05).结论CPB下左心直视瓣膜手术时,常规排气方法+2 L/minCO2充溢排气效果良好,既可防止空气栓塞,减少脑损伤,亦可有效减少术中高碳酸血症的发生,且患者伤口愈合无影响,具有一定的临床应用意义.Objective To study whether low flow and high flow have the same effect of exhausting gas and have the brain protective effect by setting different flow of carbon dioxide(CO2)during left heart surgery.Methods From October 2018 to October 2019,90 patients with left heart valve surgery under CPB in our hospital were randomly divided into three groups according to the number of patients in hospital.The experimental group was divided into two groups according to the different flow:the first group was treated with routine exhaust method+2 L/min flow,the second group was treated with routine exhaust method+5 L/min flow.The number of microbubbles,CPB assisted cardiac function time,serum S100 p level,intraoperative PCO2 and postoperative wound healing rate were compared among the three groups.Results The number of microbubbles during operation in groupⅠand groupⅡ(group I:5.9±0.6,groupⅡ:6.3±0.4,control group:9.8±0.7),CPB assisted cardiac function time[groupⅠ(16.7±2.2)min,groupⅡ(17.0±2.9)min,control group(21.5±3.1)min]were less than those of the control group(P<0.05);the serum S100P serum level[2 hours after aortic opening:groupⅠ(1.17±0.48)μg/L,group D(2.61±0.33)μg/L,control group(1.94±0.31)μg/L;24 hours after operation:groupⅠ(0.39±0.11)μg/L,groupⅡ(1.73±0.29)μg/L,control group(1.01±0.21)μg/L,all P<0.05]and PaCO2 adjustment rate of patients in groupⅡwere significantly higher than those in the other two groups(groupⅡvs.groupⅠvs control group:16/30 vs.2/30 vs.8/30,P<0.05).The incidence of postoperative poor wound healing in groupⅡpatients was higher than the other two groups(groupⅡvs.groupⅠvs.control group:9/30 vs.3/30 vs.3/30),but the difference was not statistically significant(P>0.05).Conclusion In CPB left heart operation,the routine method+2 L/min CO2 is effective in preventing air embolism,reducing brain injury and reducing hypercapnia.The wound healing of the patients is not affected,which would have some clinical significance.

关 键 词：二氧化碳 不同流量 左心直视手术 脑损伤 伤口愈合 

分 类 号：R654.2[医药卫生—外科学]