冠状动脉旁路移植术后氧供依赖关系  

The supply-dependent oxygen consumption of post-coronary artery bypass graft

作　　者：熊卫萍[1] 杨小慧[1] 吴若彬[1] 朱卫中[1] 

机构地区：[1]广东省心血管病研究所ICU,广州510080

出　　处：《中华胸心血管外科杂志》2003年第3期162-163,共2页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的　探讨冠状动脉旁路移植术后氧供依赖关系及临床意义 ,探求氧输送临界值。方法　观察 5 3例冠状动脉旁路移植术病人术毕进监护病房 (ICU)后 1、4、12、2 4、48h氧输送、氧消耗、氧摄取值 ,组间行方差分析 ,P <0 0 5为差异有统计学意义 ;各时间段氧输送和氧消耗行相关分析 ,P <0 0 5为差异有统计学意义。结果　 1h氧输送最低 ,为 36 3 88ml·min- 1 ·m- 2 ,4、12h分别为 396 0 2ml·min- 1 ·m- 2 、412 92ml·min- 1 ·m- 2 ,低于术后 2 4h的 46 8 78ml·min- 1 ·m- 2 ,2 4h后维持稳定。 12h时氧消耗最高 ,为 143 0 2ml·min- 1 ·m- 2 ,接近正常值 ( 140ml·min- 1 ·m- 2 )。 1h时氧摄取率最高 ,为 35 6 %,12h后氧摄取为 32 6 %,略低于 1h时 ,与其余时间段无明显差别。 2 4h后氧摄取为 30 2 %,明显降低并维持稳定。结论　冠状动脉旁路移植术毕进ICU后 1～ 4h时组织处于缺氧状态 ,应维持相对较高肺毛细血管楔压和心脏指数 ,提高氧输送值。重症冠状动脉旁路移植术后存在病理性氧供依赖现象 ,进ICU后 48h机体仍处于相对缺氧状态 ,此时保证供氧和降低氧消耗仍非常重要。因此 ,ICU辅助呼吸最好能维持 2 4h左右并注意肺部并发症的诊断和处理。重症冠状动脉旁路移植术后氧输送临界值为 36 3 88?Objective: To evaluate the phenomenon of post-coronary artery bypass graft (CABG) supply-dependent oxygen consumption and the critical level of oxygen delivery. Methods: 53 patients undergoing CABG were randomized selected for this study. The oxygen delivery, oxygen consumption, and oxygen extraction were studied 1,4,12,24, and 48 hours post-operatively. Data were analyzed by SPSS. Results: The oxygen delivery of post-op 1 hour was the lowest (363.88ml·min -1 ·m -2 ). The 4th and 12th hour post-operatively oxygen deliveries were 396.02 ml·min -1 ·m -2 and 412.92 ml·min -1 ·m -2 respectively, lowers than that post-op 24 hour. After post-op 24 hour, the oxygen delivery was relatively stable, and the value was 468.78 ml·min -1 ·m -2 . The oxygen consumption of post-op 12 hour was the highest (143.02 ml·min -1 ·m -2 ), which closed to the normal value. The oxygen extraction of post-op 1 hour was the highest (35.6%). The oxygen extraction of post-op 12 hour was 32.6%, slightly lower than that post-op 1 hour. The oxygen extraction of after post-op 24 decreases obviously to be relatively stable, the value was 30.2%. Conclusion: 1, Postoperative 1 to 4 hour of CABG, hypoxia exists and oxygen delivery should be increased by maintain a higher pulmonary capillary wedge pressure and cardiac index. 2,There is a pathologic oxygen supply dependency for critical patients of post-CABG, the patients is still in hypoxia post-CABG 48 hour. Therefore, it is very important to keep oxygen supply and decrease oxygen consumption. It is better that the assistant ventilation is kept about 24 hours postoperatively. The pulmonary complications should be controlled as soon as possible. 3, The critical level of oxygen delivery is between 363.88 ml·min -1 ·m -2 and 396.02 ml·min -1 ·m -2 .

关 键 词：冠状动脉旁路移植术 氧消耗 手术后 监测 氧供依赖 

分 类 号：R654.2[医药卫生—外科学]