心肺转流下冠状动脉搭桥术呼气末二氧化碳分压与心输出量变化的相关性  

Correlation between changes of end tidal carbon dioxide partial pressure and cardiac output during coronary artery bypass grafting under cardiopulmonary bypass

作　　者：陈小莉[1] 魏利娟[1] 耿素娟 马亚飞[1] 郭仲辉[1] 韩艳艳[1] CHEN Xiaoli;WEI Lijuan;GENG Sujuan;MA Yafei;GUO Zhonghui;HAN Yanyan(Department of Anesthesiology,the First Affiliated Hospital,and College of Clinical Medicine of Henan University of Science and Technology,Luoyang 471003,China)

机构地区：[1]河南科技大学第一附属医院麻醉科,洛阳市471003 [2]郑州市第七人民医院麻醉科

出　　处：《临床麻醉学杂志》2021年第3期282-285,共4页Journal of Clinical Anesthesiology

基　　金：河南省医学科技攻关计划项目(201602167);河南省科技计划项目(172102310686)。

摘　　要：目的探讨心肺转流(CPB)下行冠脉搭桥术P_(ET)CO_(2)与心输出量(CO)变化的相关性。方法选择择期CPB下行冠状动脉搭桥术的患者50例,男32例,女18例,年龄49~73岁,BMI 19~25 kg/m^(2),ASAⅡ—Ⅳ级,采用静-吸复合全身麻醉,丙泊酚、舒芬太尼、顺式阿曲库铵及七氟醚等常规剂量维持麻醉。麻醉后放置Swan-Ganz漂浮导管监测血流动力学参数:CVP、肺动脉压力(PAP)、肺毛细血管楔压(PCWP)、混合静脉血氧饱和度(SvO_(2))。采用旁路法监测P_(ET)CO_(2),采用热稀释法测定CO。记录麻醉稳定后5 min(T_(0))、CPB开始(T_(1))、CPB灌注流量降至50%(T_(2))、CPB灌注流量降至25%(T_(3))、停CPB后10 min(T_(4))、术毕(T_(5))的P_(ET)CO_(2)、CO。记录T_(1)—T_(5)时P_(ET)CO_(2)、CO分别与T_(0)时P_(ET)CO_(2)、CO的差值(记为ΔP_(ET)CO_(2)、ΔCO),进行线性相关与回归分析。结果与T_(0)时比较,T_(1)、T_(2)时P_(ET)CO_(2)、CO明显降低,T_(4)、T_(5)时CO明显升高(P<0.05)。T_(1)—T_(5)时ΔP_(ET)CO_(2)与ΔCO之间存在良好的正相关性(r_(1)=0.744,r_(2)=0.815,r_(3)=0.818,r_(4)=0.810,r_(5)=0.696,P<0.001),其中T_(2)—T_(4)时ΔP_(ET)CO_(2)与ΔCO之间的相关性更好。结论CPB下冠状动脉搭桥术P_(ET)CO_(2)与CO的变化呈现出较好的正相关性。Objective To investigate the correlation between changes of P_(ET)CO_(2)and cardiac output(CO)during coronary artery bypass grafting(CABG)under cardiopulmonary bypass(CPB).Methods Fifty patients,32 males and 18 females,aged 49-73 years,BMI 19-25 kg/m 2,ASA physical statusⅡ-Ⅳscheduled for CABG assisted by CPB were selected.The anesthesia was maintained by intravenous inhalation combined with propofol,sufentanil,cisatracurium and sevoflurane.After anesthesia,Swan-Ganz catheter was placed to monitor CVP,PAP,PCWP and SvO_(2).P_(ET)CO_(2)was monitored by bypass method and CO was determined by thermal dilution method.P_(ET)CO_(2)and CO were recorded 5 minutes after the maintenance of anesthesia(T_(0)),at the beginning of CPB(T_(1)),CPB perfusion flow decreasing to 50%(T_(2)),CPB perfusion flow decreasing to 25%(T_(3)),10 minutes after stopping CPB(T_(4)),and at the end of operation(T_(5)).The differences between P_(ET)CO_(2),CO at T_(1)-T_(5) and P_(ET)CO_(2),CO at T_(0)(denoted asΔP_(ET)CO_(2),ΔCO)were recorded and linear correlation and regression analysis were performed.Results Compared with T_(0),P_(ET)CO_(2)and CO decreased significantly at T_(1) and T_(2),and CO increased significantly at T_(4) and T_(5)(P<0.05).There was a good positive correlation betweenΔP_(ET)CO_(2)andΔCO at T_(1)-T_(5)(r_(1)=0.744,r_(2)=0.815,r_(3)=0.818,r_(4)=0.810,r_(5)=0.696,P<0.001),and the correlation betweenΔP_(ET)CO_(2)andΔCO was better at T_(2)-T_(4).Conclusion There was a positive correlation between the changes of P_(ET)CO_(2)and CO during CABG under CPB.

关 键 词：呼气末二氧化碳分压 心输出量 相关性分析 心肺转流 冠状动脉搭桥术 

分 类 号：R654.2[医药卫生—外科学] R614[医药卫生—临床医学]