心脏直视手术患者围术期胃液pH值的变化

The changes of gastric acid secretion in patients undergoing openheart surgery

目的：探讨体外循环（ＣＰＢ）心脏手术者围术期胃液ｐＨ的变化规律及其影响因素和临床意义。方法：应用便携式２４ｈ胃液ｐＨ监测仪对２４例心脏手术患者进行了监测。结果：自麻醉诱导开始，胃酸分泌受到抑制，手术中（包括ＣＰＢ期间）胃酸分泌抑制更明显，ｐＨ值持续＞４．０，手术后泌酸功能恢复约需６～９ｈ，且与主动脉阻断时间、术中低灌注和使用肾上腺素等有关。结论：ＣＰＢ、手术及围术期用药引起的胃肠道粘膜低温、缺血和缺氧是术中及术后胃酸分泌受到抑制的主要因素；胃液ｐＨ值监测在反映ＣＰＢ后胃肠道功能恢复方面具有重要意义。

Objective:To investigate the changes and its affecting factors about gastric acid secretion during perioperative period in 24 patients undergoing openheart surgery. Methods:Gastric pH was continuously monitored from the beginning of the operation to 24 h after cardiopulmonary bypass (CPB). Results:Gastric pH began to increase from the induction of anesthesia ,and kept above 4.0 during the whole operative(including CPB) period, and the decline of gastric pH after CPB to base line took about 69 h. The changes of gashric pH was related to aortic acrossclamp time,hypoperfusion and the use of adrenine. Conclusion:Gastric acid secretion is inhibited mainly by hypothermia, ischemia and hypoxia induced by CPB, heart operation and drugs. Gastric pH monitoring has an important clinic significance in reflecting the gastrointestinal secretion function after cardiac surgery.