体外循环期间氧供/氧耗平衡的临床研究  

Clinical Study of Balance Between Oxygen Delivery and Oxygen Consumption During Cardiopulmonary Bypass

作　　者：于军[1] 刘燕[1] 陈谨[1] 张达雄[1] 王中[1] 王红卫[1] 

机构地区：[1]武汉亚洲心脏病医院外科,湖北武汉430022

出　　处：《中国体外循环杂志》2003年第3期156-159,共4页Chinese Journal of Extracorporeal Circulation

摘　　要：目的　研究心脏手术时体外循环 (CPB)期间全身氧供 (DO2 )与氧耗 (VO2 )之间的变化和相关因素的分析。方法　随机选取风湿性心脏病 (RHD)、先天性心脏病 (CHD)、冠状动脉粥样硬化性心脏病 (CAD)患者共 4 2例。全组患者采用静脉加吸入全身麻醉。CPB温度 30～ 32℃、流量 (2 .4～ 3.0 )L/(min·m2 )。监测有创挠动脉压、中心静脉压、直肠温、动、静脉血气。测量及计算 :DO2 =CI×CaO2 × 10ml/(min·m-2 ) ;VO2 =CI× (CaO2 -CVO2 )×10ml/(min·m-2 ) ;氧摄取率 (O2 ER) =(CaO2 -CVO2 ) /CaO2 或O2 ER =VO2 /DO2 。结果　本组病例当中VO2 ,DO2 、O2 ER各病种组、年龄、体重之间无差异。两种温度条件下DO2 无差异。平均直肠温度为 32 .2℃时VO2 为(77.8± 2 2 .6 5 )ml/(min·m2 ) ;34.5 6℃时VO2 为 (12 9.6 2± 4 6 .87)ml/(min·m2 ) ;32 .2℃时O2 ER <2 2 %占同组的4 0 % ,34.5℃时O2 ER >30 %占同组的 71.34%。结论　CBP降温期间是形成氧债的时期 ,VO2 随降温而下降 ,DO2 无明显变化 ;VO2 的变化与中心温度上升有关 ,复温期间能够偿还氧债。使DO2 、VO2 得以平衡 。OBJECTIVE The balance between systemic oxygen delivery /oxygen consumption was analysed and correlated to factors and changes during cardiopulmonary bypass.METHODS Randomly selecting 42 patients of RHD,CHD and CAD. All patiens used venous plus inhalation anesthesia. Standard cardiopulmonary bypass methods of moderate to high pump flow 2.4～3.0L/(min·m 2). Monitoring radial artery pressure,central venous pressure,core temperature and arteriovenous blood gas measurements (mixed venous oxygen contents) . Oxygen delivery DO 2= CI×CaO 2×10ml/(min·m 2);oxygen consumption VO 2=CI×(C aO 2-C vO 2)×10ml/(min·m 2)oxygen extraction ratio :O 2ER= (C aO 2-C vO 2)/C aO 2 or O 2ER = VO 2 /DO 2 were measuremented and calculated. RESULTS There were no significant difference of DO 2 、VO 2 、O 2ER between ages, body weights, body surface areas, and types of disease. There were no significant differences oxygen delivery between 32℃ and 34℃. Oxygen consumption was (77.8±22.65)ml/(min·m 2)and(129.62±46.87 )ml/(min·m 2) at 32℃ and 34℃ respectively. Oxygen extraction<22% occured in 40.4% of all 32.2℃ group. Oxygen extraction>30% occured in 71.34% of all 34.5℃ group. CONCLUSION The study demonstrates that oxygen debt devaloped during the proceeding of hypothermic perfusion. The oxygen debt was repaid during rewarming. Oxygen delivery was constant during cardiopulmonary bypass. Oxygen consumption changes was mainly attributed to the increase in central temperaturs. Keeping balance betweeen DO 2/VO 2 . The cardiopulmonary bypass is safe.

关 键 词：体外循环 氧供 氧耗 心脏病 手术治疗 

分 类 号：R654.1[医药卫生—外科学] R654.2[医药卫生—临床医学]