体外循环对电解质和酸碱平衡及静脉血气的影响  

The Effects of Open Heart Surgery under Extracorporeal Circulation on Electrolytes, Acid-base Balance and Blood Gas Tension

作　　者：王力甚[1] 倪蓉[2] 王年云[1] 向强[1] 

机构地区：[1]湖北省荆州市中心医院麻醉科,湖北荆州434020 [2]湖北省荆州市中心医院医学检验部,湖北荆州434020

出　　处：《中国体外循环杂志》2003年第3期153-155,共3页Chinese Journal of Extracorporeal Circulation

摘　　要：目的　研究体外循环 (CPB)下心脏直视手术对电解质、酸碱平衡及静脉血气的影响。方法　选择ASAI～II级先天性房间隔缺损 (ASD)、室间隔缺损 (VSD) 2 8例 ,术前一般情况好。以咪唑安定、芬太尼和维库溴铵快速诱导插管 ,以安氟醚、芬太尼和维库溴铵维持麻醉。在劈胸骨前、转流前、转流后、停机后 15min、关胸前和术后2 4h从中心静脉抽取血样 ,立即用i-STAT分析仪检测Na+ 、K+ 、Ca2 + 、二氧化碳总量 (TCO2 )、红细胞压积(Hct)、血红蛋白 (Hb)、pH、PCO2 、PO2 、HCO3 -、BE和SvO2 的变化。结果　与劈胸骨前相比 ,转流后及术后 2 4h的血钾浓度明显升高 (p <0 .0 5 ) ;转流后TCO2 和PCO2 明显下降 (p <0 .0 5 ) ,停机后至术后 2 4h ,PCO2 明显升高 (p<0 .0 5 ) ;Hct和Hb在转流后和停机后明显降低 (分别为 p <0 .0 1和 p <0 .0 5 ) ,而术后 2 4h则明显升高(p<0 .0 1)。结论　CPB可导致血液稀释、血钾升高、二氧化碳总量和分压增加。提醒我们在转流后 ,应注意监测电解质和Hb的变化 ,并在转流结束后 ,及时加大通气量 ,以降低PCO2 。OBJECTIVE To study the effects of open-heart surgery under extracorporeal circulation on hematocrit, electrolytes, acid-base balance and blood gas tension. METHODS 28 cases of congenital ASD and VSD (ASA status I～II) were randomly chosen. Midazolam, fentanyl and vencurium were injected intravenously for induction and tracheal intubation. Anesthesia was maintained with Enflurane, fentanyl and vencurium. Venous blood samples were drawn from the central venous tube at the following time intervals: before stenotomy, before and after CPB, 15 min after pump-off, before thoracic closure and at 24-hour after operation. The level of K +, Na +, iCa ++, Hct, Hb, pH, TCO 2, PCO 2, PO 2, HCO 3 -, BE and S vO 2 was measured with i-stat analyzer. RESULTS Compared sample taken before stenotomy, the level of K+ increased significantly after CPB and 24 hours postoperatively (P<0.05); TCO 2 and PCO 2 decreased significantly after CPB (p<0.05), and the decrease of PCO 2 persisted until 24 hours postoperatively (p<0.05); Hct and Hb decreased significantly after CPB and pump-off (p<0.01 and 0.05 respectively), but increased significantly at 24-hour postoperatively (p<0.01). CONCLUSIONS Extracorporeal circulation can lead to hemodilution, the increase of blood potassium, and changes in total amount of CO 2 and PCO 2, which remind us the importance of monitoring the alterations of electrolytes and hemoglobin during CPB, and increasing the tidal and minute volume to accelerate the elimination of CO 2 after CPB.

关 键 词：体外循环 电解质 酸碱平衡 静脉血气 心脏直视手术 

分 类 号：R654.1[医药卫生—外科学]