常温心脏瓣膜置换术与冠状动脉搭桥术血流动力学及氧供/氧耗变化的比较

Intraoperative Hemodynamic Changes and Oxygen Demand/Supply Balance in the Patients Undergoing Valvular Surgery or Coronary Artery Bypass Graft Under Normothermic Cardiopulmonary Bypass

目的:探讨常温体外循环下瓣膜置换术、冠状动脉搭桥术围手术期血液动力学及氧供需平衡的可行性。方法:比较、观察常温体外循环下瓣膜置换术（20例）、冠状动脉搭桥术（21例）患者围手术期血液动力学及氧供需平衡的变化。结果:瓣膜置换术组肺动脉压、肺动脉楔入压、右房压较冠状动脉搭桥术组高,心肺分流术（CPB）前全身血管阻力系数较高,平均动脉压、心脏指数较低。脱机后儿茶酚胺用量及除颤例数组间无差异。泵流量2.6L/min·m-2、血红蛋白6-7g/dl时,可维持氧摄取率在0.32以下,混合静脉血氧分压在40mmHg以上。结论:常温体外循环下行瓣膜置换术、冠状动脉搭桥术在围手术期血液动力学及氧供需平衡方面是可行的。

Objective: The purpose of this study was to examine the adequacy of hemodynamic state and oxygen demand/supply balance during normothermic cardiopulmonary bypass (CPB) for valvular surgery and coronary artery bypass grafting(CABG). Methods: We compared and observed the changes of hemodynamic state and oxygen demand/supply balance for the valvular surgery (20 patients) CABG (21 patients) during normothermic CPB. Results: In the valve group, the patients had a higher pulmonary artery pressure, pulmonary capillary wedge pressure, right atrial pressure during pre-and post-CPB period. They showed a tendency of higher systemic vascular resistance index ( (?)VRI) and lower mean arterial pressure and cardiac index (CI) during pre-CPB period. There were no significant differences in the dose of cate-cholamines required for the weaning from CPB, and the number of patients who need defibrillation at the time of weaning. After CPB,the SVRI decreased and the CI increased to the same levels in both groups. Although the oxygen delivery decreased during CPB (pump flow was 2. 6L/min ?m-2 and hemoglobin was 6 to 7g/dl,the oxygen extraction ratio (≤0. 32) and mixed venous PvO2(≥40 mmHg) indicated oxygen demand/supply balance being kept during normothermic CPB in both groups of patients. Conclusion: The hemodynamic state and oxygen demand/supply balance for the valvular surgery and CABG during normotliermic CPB was approved.